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Published: Thu, October 26, 2017
World | By Lorena Waters

Increasing Midwifery Care in Mexico: Interview With Cris Alonso | Maternal Health Task Force

Increasing Midwifery Care in Mexico: Interview With Cris Alonso | Maternal Health Task Force

Posted on August 29, 2014

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Luna Maya is a midwife-run birth center in Chiapas, Mexico. It was created in 2004 through a MacArthur Foundation (MAF) statewide initiative to reduce maternal mortality in Chiapas. Despite the many years of interventions and investment, the maternal mortality ratio (MMR) in Chiapas had remained stagnant over the previous 10 years. We talked to Cris Alonso, the director of Luna Maya, to ask her some questions about the center and what she has done for the women of Southern Mexico.

Q.

When the MAF initiative launched, NGOs, government and experts were convened to form a commission to design an inter -institutional strategy to reduce maternal mortality. At the time, access to emergency obstetric and newborn care (EmONC) was the first line intervention in both evidence and practice. I was on the commission and we designed the proposal and it was evident that there was a lack of access to normal birth. With increased access to facility-based delivery in a country where midwives are not part of the health system, without a goal to increase access for normal births, the risk was that medical interventions, cesareans and thus maternal mortality would continuously increase adding obstetric violence to The problem.

It seems evident that the proposal also needed an expert entity in training community midwives, or TBAs, on safe delivery and to hold the space for normal birth. A logical step was the opening of a midwife-run birth center where traditional and professional midwives could train and where low-risk women could access normal birth and be referred in a timely and safe way in the case of complications.

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 for attending normal birth.

Q

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Q

Why did you choose Chiapas as the primary place for your intervention?

Chiapas had consistently maintained high MMR over the last 10 years. Safe motherhood interventions were consistently lacking in cultural competence, and homebirth with traditional midwives remained the norm. It was a logical step to keep birth at home, where women felt safe and comfortable, but to improve the skills and competencies of midwives, while at the same time improving referral networks and access to EmONC.

Q.

In my apprenticeship as a midwife I worked in an urban birth center in Guatemala City, at CASA in San Miguel de Allende in Mexico and in A rural homebirth practice in Louisiana. I was familiar with cultural competence as a pillar of midwifery care and valued continuity of care as a positive health intervention that not only improved outcomes but also increased maternal satisfaction enormously.

In my public health training I had interned And then consulted with Marie Stopes International, a reproductive health clinic that provides family planning and post-abortion care. My vision with Luna Maya was to integrate the positive aspects of a birth center with the positive aspects of a family planning center, centering the care on femifocal care throughout the lifetime, knowing that women bond with their midwives and feel comfortable receiving care from them.

Q. What is innovative about Luna Maya's model of care?

What is unique about the Luna Maya model is that it honors women's choices throughout the lifetime. Women had sexual and reproductive needs as well as other wellbeing needs. We also know that more and more women will be able to participate in this program, which will be available in the future. , etc. By working together, the medical and complementary health providers could be informed of progress and ensure best outcomes. However, Luna Maya puts women at the center of the health care decisions. We provide a plethora of providers and services and the woman can thus chose what best suits her health care values ​​and beliefs. If the woman is central to her health care program she is much more likely to adhere to treatment and attend consultations or therapy.

The Luna Maya model is therefore femifocal in that it expands much further than motherhood. It explores women's health as something that happens to all women, women who are mothers, lovers, wives, single, lesbian, stressed, infertile, raped, tired, sick, happy, exposed to STIs, deciding whether or not to continue a pregnancy, Choosing a family planning method, taking care of children, and who are part of a family system. I believe that this most reflects the reality of health, the part of a system where we take the woman as a central, intelligent agent of decisions and action.

Check back in next week for the second part of this Two part interview.

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