Why midwifery for maternal health requires a joint effort

Midwifery has a long tradition in Mexico's communities; it is increasingly practiced by women in urban areas. Maternal mortality in the country, which stands at 33.2 deaths per 100,000 estimated births, urgently needs to be reduced.

Why midwifery for maternal health requires a joint effort
It takes a joint effort to midwife for maternal health. Photo: UNAM

During the COVID-19 health emergency and the reconversion of numerous hospitals, a sector of the population in urban areas sought qualified personnel, such as midwives, to attend births, said Lucía Illescas Correa, an academic at the National School of Nursing and Obstetrics (ENEO) of the UNAM.

"There was a constant request for care because it generated anxiety and fear among the population and they sought qualified personnel to attend home births. A health professional with a degree and license can attend a birth and carry out a whole work plan, an emergency protocol," said the perinatal nurse, who has been a midwife for 30 years.

She attended a birth approximately every six months, but at the height of the health emergency, she had four requests for childbirth support in four months. "I had the opportunity to discuss this with the president of the Association of Professional Midwives and she agreed that she has attended one or two births a month in these two years," she said.

In Mexico, there is a broad cultural tradition for midwives to attend to women in their communities; in the big cities, they usually resort to health institutions, although there is also a sector of the population that increasingly wishes to carry out the birth in a natural way, with the minimum necessary interventions.

They have the skills and knowledge to make a birth plan at home, but also to identify risks and plan hospital attendance, if necessary.

Illescas Correa assured that the Mexican Official Standard NOM-007-SSA2-2016, For the care of women during pregnancy, childbirth, and puerperium, and of the newborn person, recognizes their right to express how they want the birth to develop, regarding the interventions that could be carried out.

Their care does not displace other health personnel. The differentiating component between a perinatal nurse or midwife and a physician is the broad understanding of the environment surrounding the woman giving birth that allows her to express her wishes about how she wants her baby to be born.

They can express, for example, their decision that labor should not be induced, if it is not indispensable; that if the pregnancy is full-term -40 weeks- and the baby is born crying and breathing, it should be placed on her chest to thermoregulate it, to bond with it effectively and to acquire bacteria that will help it in its life.

The university specialist expressed that everyone has the possibility of accessing these services, but in different categories or moments. "A woman with heart disease also needs health education and we can give her counseling on the process she is going through and the tools she needs to face this complication," she explained.

Knowledge and sensitivity

Since the end of 2019 and until a few months ago, about 950 pregnant women from Iztapalapa in vulnerable conditions were helped, in alliance with Red Materna and the Carlos Slim Foundation. The Foundation granted economic support for them to undergo laboratory studies and ultrasounds, while the Maternal Network did it in childbirth care.

In the case of teenage mothers, the aim was for them to have access to all possible assistance so that the experience of having a baby would be positive and they would become aware of the importance of caring for the newborn and preventing new pregnancies.

"Civil society, academia, and public and private institutions, we can do a lot and positively impact the Mexican population. We are currently looking for new organizations interested in maternal health and professional nursing training to be able to continue helping more women," she added.

Preventing maternal mortality

It is important to have a broad network of maternal, child, and perinatal specialists to help reduce maternal deaths, which are high in our country, relative to other nations. According to the Weekly Report of Immediate Notification of Maternal Deaths of the federal Ministry of Health, in week 17 of 2022, 33.2 deaths per 100,000 estimated births were registered in the country.

The states with the highest number of deaths are the State of Mexico, Chihuahua, Guerrero, and Veracruz, which accounted for 39.6 percent of deaths. The main causes: are hypertensive diseases; edema and proteinuria, obstetric hemorrhages, and COVID-19 with an identified virus, adds the report.

Illescas Correa remarked that there are countries whose maternal mortality rates do not exceed one digit. "As long as there is no investment in the training of professionals and the conditions for the care of births are not improved, complications will continue".