7 The Role of Midwives in Addressing Maternal Mortality in Latin America
Introduction
Maternal mortality is a social issue that concerns many parts of the world. The modernity and efficiency of healthcare systems are often viewed as an indicator of the development of a country or region. However, in many cases, maternal healthcare lags behind other areas of the healthcare system regardless of how developed or technologically advanced a country is. It is not possible for a country to keep its women safe or fight for the advancement of its women if it does not provide them with adequate health care, especially reproductive health care. The ability to safely deliver a child is one of the many aspects of women’s reproductive health.
Despite the importance of protecting expecting mothers, the maternal mortality rate in Latin America has risen by 15% between 2016 and 2020 (Pan American Health Organization 2023). Hospitals in Latin America cannot provide adequate services for expecting women and indigenous communities have a significantly more difficult time accessing health care services (International Monetary Fund 2005). Although different methods exist to improve women’s labor and delivery experiences, the use of midwifery may provide the most holistic care. This solution is both an ancient practice and something that has been implemented in countries around the world. It has begun to take a prominent role in addressing maternal mortality in Latin America.
The readings from this class are helpful in exploring the topic of maternal mortality because they provide context for society in Latin America. In order to comprehend why these problems with maternal health care and maternal mortality exist, it is necessary to understand the history and context of the region. Latin America cannot escape its legacy of colonialism, violence, and exploitation. It permeates into all facets of modern Latin American society. In order to fully understand its problems today and to try and reach a solution, one needs to spend time learning about Latin America’s history.
The literature readings from our class present a different perspective from the sociological ones. The narrative stories focus more on the experiences of an individual character rather than the data concerning the region as a whole. It is through the literature readings that the consequences of the health care system on women really come to light. The stories of different women, although captured in a work of fiction, depict what actually happens when a woman delivers her child in a hospital and why she might prefer to deliver her child at home. These stories are important because they humanize the facts that are learned by reading the sociological selections. The readings from the class work together to create an understanding of the society of Latin America and an appreciation of the people’s stories.
Literature Review: Sociological and Literature Readings
Sociological Readings
The use of the sociological imagination described by Stephanie Coontz in her article “How History and Sociology Can Help Today’s Families” brings us closer to understanding why women in Latin American receive inadequate health care and why the services of midwives are necessary. The sociological imagination allows someone to look at a modern-day issue and understand how the history and structure of society contributes to the problem and the circumstances surrounding it. The issue of maternal mortality in Latin America does not exist on its own. It is part of a broader history and society that interacts with the health care system and the services provided to women. In order to understand and attempt to address maternal mortality in Latin America, its history and the intricacies of its societies must be fully understood.
Along similar lines, chapter one of Open Veins of Latin America by Eduardo Galeano explores the consequences of colonialism in Latin America and provides the context necessary for one to use their sociological imagination to understand the issues in Latin America. His honest descriptions illustrate Latin America’s legacy of violence and exploitation. This reading makes it clear that many of the issues experienced in Latin America in recent times are the consequences of its colonization. Therefore, Galeano’s writing provides a chance to understand how maternal mortality fits into the larger story of colonization and exploitation in Latin America. The region’s history of exploitation creates a society of inequality, which is apparent in today’s health care system that is unable to provide adequate care for expecting mothers. This exploitation continues today and has also resulted in a dependency on industrialized nations. Latin America cannot provide its people with proper health care when it does not have the opportunity to develop infrastructure and institutions on its own without the influence of Western powers.
Literature Readings
While the first two readings provide a sociological lens through which to study the modern issue of maternal mortality in Latin America, chapter 4 of The House of the Spirits by Isabel Allende tells a story of what a woman might experience when delivering a child in Latin America. This narrative structure of the novel gives the reader a human experience to understand what childbirth looks like for an individual woman. In chapter 4, Clara gives birth at home with the assistance of Férula, her sister-in-law. Although Allende’s use of magical realism creates an unrealistic narrative of Clara’s labor and delivery, there is a sense of peace she experiences by delivering her twins at home as opposed to the traumatic delivery she had in the hospital when Blanca was born. Clara experienced difficulties while delivering Blanca that required her to be taken to the hospital and the family’s memories surrounding the event are negative. The story of Clara’s different delivery experiences begins to raise the idea that delivering a child in a hospital setting is not the best option for mothers.
Similarly, the chapter “Aunt Eugenia” in Women with Big Eyes by Ángeles Mastretta illustrates a labor and delivery experience in a hospital and highlights the inadequacies of healthcare for women. Aunt Eugenia delivered her first four children in her home with the help of her midwife and did not “get to know San Jose Hospital until she gave birth to her fifth child” (Mastretta 2004: 62). Complications during labor caused her husband to insist that they seek medical attention at the hospital. She is terrified of hospitals and convinced that strangers could not possibly care about her health or wellbeing.
Aunt Eugenia’s experience in the hospital confirms her previous perceptions. When she delivered her previous children at home with the midwife, labor was a personal experience through which she was fully conscious and in charge of the whole process. The midwife is merely a helper and her support ensures that there is no fear in the process of childbirth. Most importantly to Aunt Eugenia, she is “the first one to touch her children” (63). In contrast, at the hospital, Aunt Eugenia cannot make the decisions regarding her own body and her child. When she arrives, the doctors “put chloroform to her nose to end the discussion, and do with her what best suited them” (63). When Aunt Eugenia wakes up, her baby is nowhere in sight and she is told that he was taken to the nursery with the other children. Aunt Eugenia immediately goes to the child so that she can hold him and talk to him. Although she views this as completely logical behavior, she is scolded by the nurses and told to conduct herself in an appropriate manner.
Mastretta’s and Allende’s works are especially significant in the discussion surrounding maternal mortality in Latin America because they explore different experiences of childbirth. Aunt Eugenia’s story describes and contrasts the care received by mothers who work with midwives and those who give birth in a hospital. Both methods of delivery continue to be relevant throughout Latin America, but the rise of the maternal mortality rate by 15% between 2016 and 2020 proposes the question of whether mothers in Latin America are receiving adequate care (Pan American Health Organization 2023).
The Case: The Use of Midwives to Address Maternal Mortality
Reintroduction of Midwifery
As maternal mortality increases in Latin America, solutions need to be implemented in order to ensure safe experiences for expecting mothers. However, it is possible that a solution already exists in the practice of midwifery. A midwife is a trained professional that assists with the delivery of children (Cleveland Clinic 2022). They also provide women with additional services, such as prenatal and postpartum care, and sexual health services. Although some may view midwifery as an ancient or dangerous practice, many high-income countries such as Australia, Canada, the Netherlands, and the United Kingdom have continued to use midwives, systemically integrating them into their health care systems (The Commonwealth Fund 2023). Midwifery continues to be an effective and vital service that may actually save lives. The results of a recent analysis suggest that integrating a midwife workforce into labor and delivery health care systems in the United States would avoid 41% of maternal deaths, 39% of neonatal deaths, and 26% of stillbirths (The Commonwealth Fund 2023).
Midwifery and Western Medicine
In Latin America, midwives have been a crucial part of indigenous and rural societies. For those who are a part of these societies, it can be difficult to access health care. These communities face a multitude of barriers in trying to access care from hospitals, such as distance, lack of money, or a distrust of Western medicine. In particular, indigenous women face a disadvantage when attempting to access health care services. In a study covering Bolivia, Ecuador, Guatemala, Mexico, and Peru, there were extreme differences between maternal mortality, in-hospital births, and vaccination coverage between indigenous communities and the rest of the population (International Monetary Fund 2005). Although there are several factors at play outside of access to healthcare in the gap between indigenous and non-indigenous populations, it is important to note that midwives provide care to women who would otherwise be unable to access it. However, even though midwives are well trained in traditional methods of medicine, have an abundance of cultural knowledge, and a great understanding of natural medicines, there are instances where they are not able to keep their patients safe because of lack of knowledge or technology that can detect problems or health risks (Pan American Health Organization, World Health Organization 2023).
An emerging method of care for expecting mothers is the combining of midwifery with Western medicine in an attempt to provide the most holistic and safe experience possible (Pan American Health Organization, World Health Organization 2023). In response to the rising maternal mortality rates in the region, organizations such as the Pan American Health Organization have provided workshops and training to midwives in Latin America that focus on Western medicine and technology (Pan American Health Organization, World Health Organization 2023). By gaining familiarity with Western medicine and technology, midwives have the ability to detect problems such as gallbladder issues or appendicitis, which are treatable but fatal if not caught early on. The ability to detect warning signs of issues in a timely manner is crucial to lowering maternal mortality.
By combining traditional medicine with Western medicine, midwives are able to provide rural and indigenous women with a whole new level of maternal care. They are conscious of cultural traditions and cater to the whole person while ensuring that these women stay safe and have access to quality medical care (Pan American Health Organization, World Health Organization). Similarly, the use of freestanding birthing centers have addressed the problems that expecting mothers in the United States face. In these centers, women have the option to give birth away from hospitals and in a facility that implements a model based on midwifery and wellness. Research studying the success of these centers has shown that participating in the care they provide results in lower rates of preterm birth, lower rates of low weight births, fewer Cesarean births, and higher rates of breastfeeding following the delivery (Alliman 2022). The implementation of midwives results in all around more satisfactory maternal care in Latin American and in societies beyond the region.
Maternal Mortality and Western Medicine
In addition to making midwifery safer for indigenous and rural communities, expanding midwifery to include it to the health care system that wealthier women or those living in urban areas are able to access would improve their labor and delivery experiences and decrease maternal mortality (The Commonwealth Fund 2023). One out of four women that were involved in a study conducted in Argentina, Brazil, Chile, the Dominican Republic, Peru, and Uruguay in 2016 to assess the satisfaction women had with their labor and delivery experiences reported that they were unsatisfied with their care and experienced poor wellbeing during labor and delivery (Binfa et al. 2016). In Chile, the women involved in this study were invited to share accounts of their labor experiences in a focus group. Many of the women shared that their complaints had not been listened to, that they were not made aware of various procedures that occurred during the labor and delivery, and in some cases that they had been mistreated by members of the healthcare team. What these women shared during the course of this study proved to the researchers that Latin America has not met the goals set forth by the World Health Organization and is still far from humanizing the labor and delivery experiences of women (Binfa et al. 2016).
Women who are able to access the health care system in Latin America and deliver their children in hospitals have reported unsatisfactory care. Unsatisfactory labor and delivery services can have dangerous implications for maternal mortality in the region. Efforts to improve maternal health care services in Latin America need to focus on reforms that can be made to improve the experiences of women delivering in hospitals, not just ensuring that access is expanded. In addition to training midwives that serve rural and indigenous communities in Western medical technology, midwives should also be implemented into the existing health care system. This method has improved maternal experiences in other countries, which consequently also have lower maternal mortality rates (The Commonwealth Fund 2023).
Analysis: Applying the Theoretical Framework to the Use of Midwifery
Coontz, Galeano, and the Gap in Health Care
The readings by Stephanie Coontz and Eduardo Galeano support the data regarding the role of midwives in addressing maternal mortality in Latin America, especially in indigenous and rural communities. Coontz describes the sociological imagination, or how by understanding the history and sociology of a society, one can understand why certain issues exist and what the best way to address them is. Using the sociological imagination and the information about the colonization of Latin America provided by Galeano, contextualizes Latin America’s health care system and how indigenous communities fit into it. The colonization of Latin America and the society that emerged created a hierarchy in which indigenous people exist at the bottom. As a consequence of the exploitation and genocide of Indigenous communities in the past, many continue to live disadvantaged lives.
The oppression of indigenous people today has created a gap between their communities and the rest of the population in many factors of quality of living, especially health care. These communities often live apart from urban centers and are unable to access health care services due to distance. In many cases, indigenous communities live in poverty and cannot afford to pay for health care services. 43% of indigenous households experience material poverty and extreme poverty is 2.7 times greater in indigenous communities than in the rest of the population (United Nations Development Programme 2020). Given the difficulties indigenous people experience in the face of this poverty, it is not surprising that accessing health care may not be a priority. In addition, the grievances committed against indigenous populations in the past described by Galeano and that continue to occur today have resulted in a distrust of Western institutions and medicine. Using the sociological imagination and the information provided in Galeano’s Open Veins of Latin America to understand why indigenous communities are so vulnerable to maternal mortality it becomes clear that midwives are providing a solution to a problem that is centuries in the making.
Open Veins of Latin America also connects to a different aspect of maternal health care in Latin America. Through the sociological imagination, Latin America’s colonial past has a direct influence on its modern systems. Even as an independent region, Latin America cannot offer its citizens adequate health care, at least in part, because it was colonized and exploited in its past. Despite the region’s advancements and modernization, there are limits that exist to how well it can serve its citizens because of the legacy of colonialism which has consequences for expecting mothers who are trying to receive care from the health care system.
Mastretta, Allende, and In-Hospital Delivery
The readings by Mastretta and Allende include conflicting descriptions of delivering a child at home and delivering a child at a hospital. Both these selections depict delivering at a hospital as something to be avoided. Hospitals are impersonal and the medical staff do not truly care about your wellbeing or providing holistic care. Aunt Eugenia experienced this while giving birth to her fifth child, which is why she avoided delivering at a hospital until complications made it absolutely necessary.
In The House of the Spirits and the chapter “Aunt Eugenia”, giving birth at home is an empowering experience for Clara and Aunt Eugenia. Mastretta especially highlights how the role of the midwife contributed to this positive birth experience. Aunt Eugenia is in total control of the experience, unlike hospitals where she is drugged and many women in Latin America have reported that they were unaware of procedures that took place during their delivery (Binfa et al. 2016). The midwife is there to provide assistance and guidance, not to control Aunt Eugenia’s body. Implementing midwives into the health care system in Latin America will allow women to have more bodily autonomy and control over their labor and delivery experiences, which in turn improves maternal health and maternal mortality rates.
Conclusion
I began my exploratory essay with an interest in the health care services available to expecting mothers in Latin America. In both the readings completed in class and the research I conducted there are examples of a lack of autonomy and holistic care. Combined with the region’s inability to provide all of its people with adequate health care, maternal mortality rates are increasing. Women in Latin America need access to reproductive care that caters to all of their needs and allows them to be in control of a truly vulnerable but empowering moment.
Midwives have a crucial role in addressing maternal mortality in Latin America. Expanding the role they play in hospital settings allows women who choose to deliver in hospitals to have a safer and more satisfactory labor and delivery experience (The Commonwealth Fund 2023). In addition, midwives provide care to women that the health care system forgets. Women living in indigenous or rural communities have a difficult time accessing health care services and the ability to visit a midwife allows them to seek care during their pregnancy, labor, and delivery. In order to take advantage of the work midwives do in these communities and combat maternal mortality, the Pan American Health Organization and the World Health Organization host clinics where they provide these midwives with Western technology. This technology fills gaps that might have existed in their knowledge and midwives can now detect and address potential problems in a woman’s pregnancy.
The data surrounding midwives suggests that the best way to address maternal mortality and ensure that women in Latin America have satisfactory birth experiences is to combine modern medicine and tradition. The use of midwives can ensure that women have a birth experience similar to Aunt Eugenia’s in which they are in control of a moment that is both intimate and empowering while the use of modern technology and a knowledge of Western medicine work to prevent fatal issues.
References
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