Nora E. Jaffary: Midwifery in Mexico

Reproduction and Its Discontents in Mexico: Childbirth and Contraception from 1750 to 1905, by Norah E. Jaffary, cover imageIn a history of childbirth and contraception in Mexico, Reproduction and Its Discontents in Mexico: Childbirth and Contraception from 1750 to 1905, Nora E. Jaffary chronicles colonial and nineteenth-century beliefs and practices surrounding conception, pregnancy and its prevention, and birth. Tracking Mexico’s transition from colony to nation, Jaffary demonstrates the central role of reproduction in ideas about female sexuality and virtue, the development of modern Mexico, and the growth of modern medicine in the Latin American context.

In today’s guest post, in honor of International Midwifery Day, Jaffary describes the history and importance of midwifery in Mexico.


Midwifery in Mexico

In addition to commemorating Mexico’s defeat of Imperial France in the Battle of Puebla in 1862, May 5 is also designated International Midwifery Day by the United Nations Population Fund. Despite being marginalized health care providers in Mexico since the mid twentieth century, in recent years, midwifery is in resurgence.

Midwives were the dominant obstetrical and gynecological practitioners in Mexico in pre-Hispanic and colonial Mexico. Their medical knowledge was vast. Early post-conquest writers observed that Mexican midwives possessed hundreds of medical remedies to provide contraception, encourage fertility, counteract the side effects of pregnancy, assist in complicated deliveries, and treat postpartum complaints. They could soothe labor pains, initiate stalled labor, facilitate the placenta’s expulsion, encourage lactation, and soothe that most vexatious of post-partum symptoms: hemorrhoids.

Unlike in much of western Europe and the United States, midwives remained the dominant practitioners of obstetrical and gynecological care in Mexico throughout the colonial period and the nineteenth century. This may have been in part because women understood that the medical care midwives provided was more effective than that of physicians. The European-infused medical tracts the viceroyalty’s physicians endorsed included suggestions such as advising women experiencing stalled labor to drink solutions of horse manure diluted in wine—presumably because this was a substance so disgusting it would provoke vomiting, which in turn might accelerate labor contractions. Mexican midwives were more likely to encourage clients who found themselves in in such situations to drink a tea of cihuapatli, the aster flower, a plant whose chemical properties current medical research has substantiated acts as a powerful oxytosin, or labor accelerator, and which can also be used efficaciously to prompt an early miscarriage and to reduce bleeding following delivery.

a physician conducts a gynecological examWomen also chose to continue frequenting midwives rather than physicians in Mexico because women were more at ease with midwives’ physical familiarity with all phases of their biological lives. It was a period when physical intimacy between men and women (even in medical contexts) was scrutinized and suspect. How could late colonial and early nineteenth-century physicians have been expected to effectively examine their patients, when they were encouraged to conduct gynecological exams on women whose genitalia they could not see?

Despite midwifery’s persistence through the nineteenth century, by the mid twentieth century, the Mexican state effectively stifled the practice. After the Mexican Revolution of 1910-17, the state established maternity hospitals around the country, and after 1944, with the creation of the Institute of Social Security, the state seized greater control of all types of health care provision to Mexican families. Although in the 1940s and 50s, most birth attendants in state-run institutions were midwives, by 1960, the state prohibited midwives from attending to women at birth in its institutions. Although there were roughly the same numbers of licensed doctors as midwives practicing in Mexico, by the turn of the twenty-first century, doctors outnumbered midwives by 125:1.

This situation, as the New York Times has recently reported, has contributed to two dire features of current birth practices in Mexico. First, in poor rural areas such as the southern state of Chiapas, where physicians are unlikely to operate, as many as 55 out of every 100,000 women die in childbirth. Second, in the institutionalized birth centers where the majority of women in urban settings now give birth, inordinately high proportions give birth via caesarean section. While the World Health Organization recommends that caesarean sections should constitute no more than 15% of a country’s total births, by 2009, fully 85% of women’s births in Mexico’s private clinics resulted in caesarean births.

Mexico has begun attempting to rectify this situation by revitalizing the formal instruction of midwives, including the Centro de Adolescentes de San Miguel de Allende (CASA), established in 1981, which offers a four-year training program in midwifery, and new birth centers such as the one built in San Juan Chamula (Chiapas), where midwives have access to training and services to deal with emergencies like infection and high blood pressure, but where women can also use pre-Columbian practices, such as sustaining themselves from ropes suspended from the ceiling while experiencing contractions.

If all goes well, Mexico will resurrect its colonial habits in its contemporary obstetrical health care practices—that is, a health care that is truly hybrid, borrowing the most effective of pre-Columbian and European and African elements.

Nora E. Jaffary is associate professor of history at Concordia University in Montreal. Her book, Reproduction and Its Discontents in Mexico: Childbirth and Contraception from 1750 to 1905, is now available from UNC Press.