In labor: Birth centers in Mexico
In Mexico, BCs are usually private or constituted by some civil association. BCs cannot be designated under this name (birth center), because the Ministry of Health does not recognize their legal status for providing birth assistance within their facilities.
One way in which Mexican BCs have been dealing with this problem is by registering the facility under the legal figure of a hospital or specialized clinic. However, the national norms require that these facilities exceed the minimum requirements indicated by Comisión Nacional de Arbitraje Médico (Mexican National Commission for Medical Arbitration: CONAMED) for attending low-risk births, namely:
Approximately 70 per cent of the obstetric population has no risk factors, their control is simple, and they do not require high-cost infrastructure. The basic equipment required by the obstetrician consists of a physical place with adequate lighting, [ventilation (preferably natural) and temperature], a gynecological table, sphygmomanometer, thermometer, clinical scale with height scale, tape measure, Pinard’s stethoscope, gynecological examination gloves, vaginal specula, and clinical record.
(CONAMED 2012, 15)
As will be shown in this chapter, the visited BCs comply with these norms. Hence, a need exists to legislate in favor of BCs so that they are named in the norms as specific centers for medical care in accordance with the indications of CONAMED.
The BCs that function as part of a hospital or as specialized clinics must also tackle the obstacle of fulfilling the norm’s requirement to have a professional person in charge of the facility. This person cannot be a midwife because, in Mexico, midwifery is barely recognized as a profession, and only in some states, and not explicitly even then (Sánchez-Ramirez 2016). In addition, although the regulation that deals with the provision of medical services formally provides that non-professional staff (technically trained staff) can attend births, in actuality this practice is only allowed in rural, communitarian contexts. These allowances are also subject to multiple other restrictions by the Health Ministry (López-Arellano et al. 2020).
Thus, suffice to say that the regulation of midwives—professional, empirical or traditional—does not exist in any clear, effectual legal or normative framework in Mexico (López-Arellano et al. 2020). In other words, Mexico’s adverse conditions for BCs and midwives have driven both groups to operate clandestinely or in semi-secrecy.
Despite these adverse conditions, BCs do exist in our country, and function as spaces adapted to particular homes or facilities. Their role is to offer a comfortable environment for women who seek to give birth there, accompanied by their partners, family and friends. These birthing women are assisted by a midwife, who accompanies the process of birth, and by one or more doulas. These BCs can be found in Mexican middle-sized and large cities. Their costs vary—not all Mexicans can afford them. For that reason, Mexican BCs cover a very small sector of the population (middle-class, and upper middle-class). Most women who seek these spaces have high school or university education. Some are Mexican, and others are foreigners living in Mexico. The BCs are usually announced on the internet, or in the networks of women who have used the services before and communicated their preferences to their peers. This factor, too, limits the type of women who find out about and seek the BCs (Sanchez-Ramirez 2016).
It is also worthwhile clarifying the nature of BCs, and distinguishing them from those spaces that form part of the official healthcare system: the so-called maternity homes (casas maternas). These are spaces opened in locations with high maternal mortality. The objective of maternity homes— annexed to hospitals—is for midwives or health staff to examine pregnant women and provide prenatal care; however, at the moment that women are about to give birth, they are usually transferred to the closest public hospital facilities. These maternities depend on the Health Ministry, and are particularly focused on attending the Indigenous population or women with lower economic resources (Cruz et al. 2015). Unfortunately, no published studies assess the effectiveness of maternity homes in lowering maternal mortality, or the re-signifying of traditional midwifery in rural areas in terms of maternal care before and after birth. Midwives are not usually allowed to attend women during birth in these maternity homes. Thus, these spaces have been criticized for reducing traditional midwives to a mere assisting role, rather than a model for prioritizing the autonomy or body-territoriality of the birthing woman.
In contrast, BCs in Mexico do not belong to any official system, due to their specific definition described above. They are located in urban zones with their own model of care. Their heads are professional midwives who combine modern medical knowledges with traditional midwifery and their own contemporary experiences (Lopez-Arellano 2019). In Mexico, the BCs fight constantly to win and maintain space as a different model of maternal and neonatal care.
