Magali López Fabila
Lead Midwife and Midwifery Coordinator
Advanced Midwife Apprentice
Luna Maya Chiapas was founded in 2004. Since then, it has served more than 2,500 families and has offered low-cost or financed pregnancy, delivery, and postpartum care to indigenous women from vulnerable neighborhoods and communities near San Cristóbal de las Houses, Chiapas.
Luna Maya is a development in the history of midwifery in Mexico. Midwifery has been practiced in Mexico for more than a thousand years. But midwifery declined from the 1950’s as attention moved to the biomedical model of obstetrics. With this change came criticisms of massive institutionalization and the over-medicalization of birth. Problems have included high rates of Caesarean sections, lack of culturally sensitive services, and even obstetric violence. A new generation of professional midwives in the country (both from Mexico and abroad) proposed alternate midwifery pathways as potential solutions to these problems.
Luna Maya was created in 2004 through a MacArthur Foundation state wide 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 home birth 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 (midwifery centers) for attending normal births.
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. 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. Mothers participate in 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 Chiapas. In addition to family planning and birth services, women receive health services at the center 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 a lack of clear state regulation for midwifery and independent birth centers, lack of inclusion of professional midwives in the Mexican health system, and lack of funding for independent birth centers. Luna Maya is politically active in seeking ways to work with the Ministry of Health to find ways to regulate midwifery and birth centers.
Additional program notes
- Staffing: 1 full time midwife plus apprentices
- Historically, the Cesarean section rate for women initiating pregnancy care at Luna Maya in Chiapas is 7.8%
- Home visits are provided before and after birth.
- Women’s health education programs
- Childbirth preparation course
- Midwife camp
- Acupuncture training
- Doula training programs
- Transfers are to public and private hospitals in San Cristobal de Las Casas
- Integrated health systems and approaches, based on trust and confidentiality, empowers women around birth.
- Examples of respected local practices and knowledge include the use of the Mayan rebozo (a woven traditional shawl) technique during labor.
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