The practice of midwifery in Mexico is a millenary profession. But since the decade of the 1950’s, midwifery has had an important decline as attention moved to the biomedical model of obstetrics. With this change has come criticisms of massive institutionalization, the over-medicalization of birth (including high rates of Caesarean sections), lack of culturally adequate services, and obstetric violence. A new generation of professional midwives in the country (both from Mexico and abroad) are proposing alternate pathways and potential solutions to this problem. It was in this context that Luna Maya was created in 2004 through a MacArthur Foundation statewide initiative to reduce maternal mortality in Chiapas. Luna Maya was founded to humanize health services in Mexico under the midwifery model of care. The Luna Maya midwifery-led birth center in Chiapas was opened in 2005 and in Mexico City in 2015.
Chiapas was a state where homebirth with traditional midwives had remained the norm and where safe motherhood interventions were consistently lacking in cultural competence. The founder of Luna Maya, Cristina Alonso, a public health professional and midwife, thought that it was a logical step to keep birth at the primary level, where women felt safe and comfortable, but to improve the skills and training of both traditional midwives and new midwives, while at the same time improving referral networks for access to emergency obstetric and neonatal care (EmONC). There was also an urgent need to document the safety of midwifery-led care. The Luna Maya model, therefore, was conceived as a pilot project to demonstrate the efficacy and cultural pertinence of midwifery-led, primary level care units (birth centers) for attending normal births. The birth center in Chiapas accomplished this. Luna Maya expanded to the capital of Mexico City 10 years later and opened a second center.
The midwives at Luna Maya provide continuous care to the women they serve. Births are attended both at women’s homes and at the birth centers. Luna Maya through both birth centers provides attention to more than 2,500 families per year. In their 11 years of attention, more than 500 births have been attended with loving, evidence-based, and quality care. Midwives provide gynecological services including pap smears, family planning, support for incomplete abortion and general holistic women’s health care. In addition to midwifery care, each center provides medical and alternative health services including acupuncture, community classes, and workshops (subjects include childbirth education, infant massage, infant development, breastfeeding, mama support groups, women’s circles, dance and body awareness classes). The workshops are taught by midwives and other collaborative staff. A Doula training program once a year and courses for midwives and health care providers are also offered. Luna Maya provides care to patients of all socio-economic levels and ethnicities. Patient fees for health services are on a sliding scale. Crowdfunding campaigns are carried out annually to enable subsidizing services.
Luna Maya has developed a midwifery training program through the apprenticeship model. It is currently the only formal midwifery education program in Chiapas and the only apprenticeship based model that continuously graduates students. Students are selected through prior experience and demonstrated commitment to midwifery. Their program is 18-24 months, depending on the time taken to complete clinical requirements. Students teach childbirth education classes. They are evaluated through peer review conducted weekly, clinical competency examinations, and performance simulations. Students complete the ICM and NARM competency requirements. However, graduates are not recognized for their achievement by the Ministry of Education because their training is informal. Instead, graduates are register as traditional midwives.
Luna Maya is honored by the humanized birth and midwifery community in Mexico. Luna Maya is respected as a leader for enabling birth centers, families, and communities. The Luna Maya midwifery model – with its femifocal approach to care – has proved to be successful in both Chiapas and Mexico City, providing not only family planning and birth services, but acting as a family health center which accompanies women throughout their lifetime. Midwives and women look to Luna Maya as a reference for implementing a model that honors the reality of women´s life cycles and healthcare decisions. As the first midwifery-led birth center in Chiapas, Luna Maya has had to find creative ways to surpass political and cultural obstacles in order to maintain the sustained delivery of women’s health care options. Some of these challenges have included unclear or lacking state regulation of midwifery and independent birth centers, lack of inclusion of professional midwives in the Mexican health system, and lack of funding for independent birth centers. In 2017 Luna Maya will be starting a project to create a guide, indicators, and training for opening more birth centers. Luna Maya is seeking ways to work with the Ministry of Health to find ways to regulate midwifery and birth centers.
Noteworthy Good Birth Practices
- Continuity of care during pregnancy, birth and post-partum by the same midwife and midwife apprentices. Facilitated childbirth education and mothers’ groups.
- Couples receive continuous care during labor and home visits during the first week after birth.
- For planned homebirths, the last pre-natal checkup is also given at home, so that the midwives can get to know the place where the birth will take place.
- No maternal deaths have been registered and a 95% of exclusive breastfeeding mothers at 6 weeks postpartum is maintained.
- Luna Maya’s femifocal approach to care – a model that listens to women, respects their capacity to integrate health systems and approaches, and is based on trust and confidentiality – empowers women around birth.
- Location: Chiapas, Mexico; and Mexico City (DF), Mexico
- Established: 2004
- Staffing: 1 midwife, 2 apprentices (Chiapas) & 2 midwives, 3 apprentices, 1 support person, 1 acupuncturist, 1 ovaric breathing, 1 hipopressive, 1 breastfeeding counsellor (DF)
- 3-4 deliveries (Chiapas) & 6-8 deliveries (DF) per month
- 81 clinic visits (Chiapas) & 40 clinic visits per month
- 7.8% Cesarian section rate (Chiapas) & 10 – 13% (DF)
- Home visits (one pre-natal for planned homebirths & 2 post-natal)
- Women’s health education programs & Doula training programs
- Transfers: Public hospitals: Hospital de la Mujer (emergencies); private: Hospital de la Caridad (Chiapas).
Public hospitals: Hospital de los Venados; & private clinics: Sanatorio Durango, Medica Sur Lomas, et al.
Examples of respected local practices and knowledge
- Use of the Mayan rebozo (weaved traditional shawl, about 1-1.5 meters long) technique during labor. It is performed during pregnancy or the first stage of labor to accommodate the baby inside to an optimal position, and to relax the birthing woman’s pelvic muscles (thus helping birth progress more efficiently). It consists in carefully moving the pregnant or birthing woman back and forth with a rebozo cloth or sheet, with the woman lying directly on top of the rebozo, or in other positions, with the rebozo placed over sections of her body and gently moved back and forth (manteada).
- A cloth is tied around a high wooden beam, from where the birthing woman can pull down, to help her transit through rushes (contractions).
- A Mayan traditional rebozo “closure” and postpartum traditional herbal bath is encouraged for the new mother to be taken at Luna Maya around 1 month after birth.
Cynthia Ingar, 2016