The politicization of autonomous midwives in Mexico

Midwifery activism in Mexico, particularly in its organizational forms, has been observed empirically since at least the 1980s. In 1989, the civil association Las Parteras TICIME was established in Mexico City and Tepoztlan, dedicated to promoting midwifery and to liaising between professional and traditional midwives. From its inception, the association was linked to midwifery activism in the USA, in order to explore avenues for professional midwifery in Mexico. In one of my interviews, conducted in February 2015, the TICIME midwives stated that their activism began because all the midwifery schools in Mexico, which for decades had graduated parteras tituladas (“titled midwives”)—professional direct-entry midwives who practiced in hospitals— had been closed in the 1970s, and midwives had been thereafter excluded from hospitalized deliveries (see Chapter 1, and Carrillo 1999). The decision to eliminate the partera titulada was made by obstetricians who wanted to get rid of the competition; from one day to the next, these professional midwives, who were quite competent practitioners, were forced out of practice. In addition, in the rural areas of the country, an inquiry emerged as to what to do about midwives who learned the craft from their mothers and grandmothers (Sanchez 2015).

I emphasize in this chapter that contemporary midwifery advocacy was not born in an isolated context or only out of a desire to practice a salaried profession from a subjugated position. These professional—and also material— aspects are definitely part of midwives’ global and Mexican struggles, yet advocacy for the profession was born at a particular conjuncture, characterizedby increasing awareness of women’s rights, criticism of the biomedical system and anti-systemic global movements combined with the particular situation of midwifery in the country. For example, in the case of TICIME, whose members have pioneered autonomous Mexican midwifery advocacy in the context of this reemergence, the drive for midwifery was born from the search for options to change from mechanically attended hospital births to more natural births in which women could exercise greater freedom over their bodies.⁸ In other words, the impetus to become a midwife, in this case, implies in itself a political awareness arising from personal experiences. This awareness is linked in turn to an awakening of feminist mobilizations in defense of women’s rights. The activist midwives oppose obstetric violence and do not conform to the dominant biomedical system as related to reproductive life. In this sense, in Mexico and globally, the struggle for the midwifery profession expanded from the personal to the political struggle for high-quality sexual and reproductive healthcare, and for more natural births. In the Mexican case, the struggle also involved a complex building of bridges between traditional and professional midwives.⁹

Since the establishment of TICIME, there has been an increasing process of establishing midwifery associations in various parts of Mexico. The year 2004, for example, saw the establishment of the Casa de Partos Luna Maya in San Cristobal de las Casas, Chiapas, and the association Nueve Lunas in Oaxaca City, both led by midwives whose approaches combined human rights and humanization of birth. This generated the interest of young people to become midwifery apprentices and the establishment of new, similar associations, such as the Association of Midwifery and Natural Health in Chichihuistán, Chiapas, and the Casa de Parto Osa Mayor in Tulum, Quintana Roo—both in operation since 2013. Both Nueve Lunas and Osa Mayor seek to promote “midwifery in the tradition” (partería en la tradición), which distances itself from medically trained nurse-midwives—the LEOs—and is based upon rituals, cultural roots and wisdom emerging from traditional communities (see Chapter 5). The midwifery in the tradition trend also forms an organic movement of school networks at the Latin American level.¹⁰

In addition to founding associations, midwives have been creating informal advocacy networks based on the capabilities and personalities of different midwives found in these networks. These networks extend throughout the country. For example, my interlocutors consistently mentioned the organizational efforts of several specific midwives in Veracruz. Also mentioned was a famous traditional midwife of Temizco, Morelos, Angelina Martinez Miranda, who, in addition to receiving a large number of national and international apprentices, actively teaches in international midwifery conferences. Indeed, it is important to note that much of the midwifery mobilization and awareness raising takes place via social media networks. For example, the AMP’s Facebook page offered and publicized a wide range of information, including services related to midwifery, the humanization of childbirth, obstetric violence and discussions of women’s rights. In my interviews, several

She breaks paradigms and leaves a trail 77 midwives commented that the amount of information that women request via these means is almost “scary,” and that it definitely represents an administrative challenge.¹¹

A fundamental axis in this contemporary organizational effort has been the previously mentioned AMP. Established in 2012, it aims to bring together the various associations dedicated to midwifery. Fundamentally, the AMP has tried to create a common agenda to represent and defend midwifery in Mexico’s particular context.¹² The mission to strengthen the midwifery profession in Mexico is based on a model that emphasizes women’s sexual and reproductive health. The mission promotes women’s autonomy and rights, as well as education and training for new midwives. One goal of that mission was, at least at the time of this research, to establish a College so that the midwives themselves can regulate and certify their professional practice. Autonomy is again a key factor: the AMP wanted to ensure that midwives are the ones who make the fundamental decisions about their profession, and about the grounds on which someone can qualify as a midwife.¹³ Within this association, the concept of autonomy fundamentally refers to the professional one.

However, it is also important to note that not all midwives share the AMP’s vision: there have been heated discussions within the association on the certification and regulation of midwifery in Mexico. Complicating the situation further, the AMP also includes members who are not midwives but rather interested consumers who have their own takes on what Mexican midwifery should be.

My research results suggest that the profession, politics, autonomy and women’s rights tend to go hand in hand, supporting each other in the case of contemporary Mexican midwife-activists. Thus, awareness of these issues results from the intersections among movements and the conjunction of events related to one’s own experiences and transformations that push women toward the decision to become midwives. These new midwives then continue to strengthen their mobilization based on these concerns.

In my analysis, the following four issues have an interrelated influence on the decision to become a midwife and to mobilize an autonomous midwifery movement:

• 1. Personal experience—bodily autonomy—in childbirth. For mothers who had positive and empowering homebirths, the decision to become a midwife stems from wanting to empower other women to have this experience. In contrast, mothers who have negative and disempowering birth experiences in hospital choose to become midwives in order to combat obstetric violence, disrespect and abuse, and to offer more loving services to other women. Many doulas, who have created their own social movement, make the decision to practice that vocation for similar reasons.
• 2. The desire to act for women’s sexual and reproductive autonomy after a process of becoming aware of reproductive rights and health, women’s rights and the general criticism of the biomedical system. Many of theinterviewed midwives had previously participated in other movements, or were influenced by (for example) anthropological literature related to natural or humanized births. A common thread in that literature is the criticism of the biomedical system regarding reproductive “management.”
• 3. The influence of anthropology and/or Indigenous traditional midwives. The majority of the midwives interviewed have higher education, including in anthropology and sociology. Several have collaborated, in one way or another, with Indigenous or traditional midwives and/or Indigenous communities. They wish to learn from or with them, and have a desire to “return to the roots” and recover, in postmodern form, the ancestral and natural capacities of women, both to give birth and to take care of other women during labor. Some of the recovered capacities involve rituals, herbs and massage (sobada). Several of my autonomous interlocutors shared an interest in alternative medicine—for example, homeopathy.
• 4. Intersections with new activisms or current ideologies—which tend to emphasize political autonomy—both within Mexico and Latin America but also extending beyond the continent. In general terms, it can be said that several activist midwives share certain issues and links with other activisms, including: (a) being anti-systemic or being discontented in some way with the current system; (b) being feminist or femifocal/matri-archal; and (c) being influenced in some way by New Age tendencies linked to certain forms of spirituality; the revalorization of nature; “deschooling” and homeschooling; and the “new farmers” engaged in creating ecovillages or ecological farms. In some cases, these shared linkages involve the defense of Indigenous rights.

In addition, several points of politicization emerged during the interviews. Some of those points already existed among the so-called autonomous midwives, while other points were exterior, in relation to other midwives or the field of midwifery in general in Mexico. These points include the following factors, which are also interlinked:

• The territorial dispute or turf war between the biomedical system and midwifery, both globally and nationally. Autonomous midwives criticize the ways in which the biomedical system has appropriated births and women’s bodies; hence, they define themselves as anti-systemic (“autonomous”) in the search for femifocal maternal care that would respect women’s own knowledge of birth as a right, while emphasizing human rights in childbirth that can be honored by midwives. Obviously, these arguments have generated—and continue to generate—a strong reaction in the medical field. Some midwives with medical ties seek to emphasize the complementarity of the two types of knowledge systems—obstetric/ midwifery, or technocratic/humanistic-holistic—but most interviewees noted a severe division between the two.

• • The definition of midwifery.¹⁴ The autonomous midwives 1 interviewed represent a sort of midwifery that emphasizes the autonomy of their profession along with key elements of criticism of the dominant medical system, which is why they have chosen to work autonomously/organ-ically/holistically. However, they also collaborated and sought to create their own protocols for midwifery care. This emphasis generates tensions with the biomedical trajectory of the LEOs. It also generates tensions around the issue of certification, because there is a debate about whether the path toward certification must be excessively academic, and whether any type of certification could be sufficiently inclusive for all the kinds of midwives in the country. The tension between nurse-midwifery and autonomous/organic/holistic midwifery, as well as between the midwifery models more inclined toward the career-academic and/or the empirical, prevails globally.
• • For whom does midwifery in Mexico exist? This is a tough debate, particularly among the autonomous midwives, who are under the critical lens fixed on the ethnic and social class structure because of their predominantly urban, middle-class backgrounds. In similar vein, as noted earlier regarding the criticisms of new, largely middle-class social movements, autonomous midwives are criticized for the price of their services. Because of those prices, their clients are mostly urban, middle-class women, which is a problem in a country as full of inequalities as Mexico. Another sharp criticism is directed at the relationship between the autonomous midwives and the Indigenous and traditional midwives. On the one hand, it has been alleged that autonomous midwives have ignored the existence of the Indigenous/traditional midwives. On the other hand, it has been alleged that when there is an attempt at collaboration, the result is inevitably the “appropriation” of the Indigenous/traditional knowledges. This axis of politicization is strongly linked to the attempt to legalize and certify midwives, and of course to the discussion around what type of midwifery is needed in Mexico: Who are the women who can access this service, and who are the ones that have the right to provide it?

These three major tropes form the key to understanding the politicization of midwifery in Mexico, which is made visible, in the case of autonomous midwives, by the interaction between human rights and the question of class within the framework of social movements. In other words, there is vacillation between material values, class issues, human rights and social movement activism derived from the critical societal stance, just as addressed by the new social movement theories. The interviewed midwives, whatever their different visions, have all been able to argue that midwifery is for all women in Mexico, and that the vision of midwifery should therefore be expanded in the country. These midwives are unanimous in thinking that midwifery-centered homebirth should be for every woman and that midwives are not merely women with low economic resources (as traditionally perceived in the country).

Yet, the autonomous midwives tend to feel that, because of their location in middle-class and urban contexts, and because of the risks and liabilities of their work, they are entitled to charge for their services so that they can make a living. They point out that their particular purpose is not necessarily to go to communities where there are already midwives who were born in that particular context and raised to the craft in those particular communities. However, as previously indicated, some autonomous midwives are indeed located in rural contexts.

The midwives interviewed for this study were quite aware of the tensions related to the various intercultural and interclass aspects. Several of these midwives have been building bridges with Indigenous midwives for decades (this topic will be deepened in Chapter 5). However, this issue makes visible a particular tension among professional and Indigenous midwives, the latter of whom defend their knowledge in the framework of the rights of Native peoples.

In the two “herstories” of autonomous midwives in Mexico provided below, we can perceive not only these tensions but also the ways in which the concept of autonomy is articulated within this kind of contemporary midwifery activism in Mexico as part of broader women’s rights concerns since the 1990s.