TZAJALCHÉN — “M’Etik Lucía, M’Etik Lucía.” It’s 5:10 in the morning, and someone is knocking at the window of Lucía Girón, whispering loud enough for her to wake up and go to the window. Pedro Luna is in a hurry. With effort, his wife, María Guadalupe, climbs out of the badly parked car, her prominent belly showing under her traditional dress.The night is still thick, and she is in labor.
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A few minutes later, Lucía enters her small office wearing a blue gown, a mask and her traditional long braids. Pregnant María Guadalupe, a Tzeltal indigenous woman, walks behind her. She lies down on the wooden cot that serves as a stretcher and the most famous midwife in the Tenejapa Municipality, in the Chiapas Highlands of southern Mexico, puts on latex gloves. She begins her mission: bringing life.
Lucía, a 49-year-old Tzeltal, has been helping women in her community give birth for three decades — a skill she learned from her mother-in-law. Her own first child died due to complications during childbirth. For her second child, she held on tightly to a tree near the house and pulled the baby out with her own hands. Since then, this traditional midwife has not stopped learning, practicing and sharing with other midwives and nurses in the region.
Her mission is to prevent maternal and infant deaths — a job that has no schedule or breaks.
Mexico is at the top of the list of maternal mortality in Latin America. The Maternal Mortality Observatory in Mexico (WMO) has recorded 152 deaths in 2024 as of early May.
Filling in for the State
In the indigenous communities of the Chiapas mountains, the number of health centers can be counted on one hand. Chiapas is the Mexican state with the highest percentage of the population living in poverty: 67.4% of its inhabitants in 2022, according to figures from the National Council for the Evaluation of Social Development Policy (Coneval).
It is also the second state with the highest maternal mortality and the first in teenage pregnancies. There are no schools, too few hospitals and not enough money in the pocket of peasant and indigenous women to go there. Where the state fails to provide, is where women like Lucía come in, ancestral midwives or Tam Unem, in the Tzeltal language. A pre-Columbian profession celebrated on May 5, International Day of the Midwife, set by the United Nations in their honor.
There are no signs indicating Lucía’s house, in the community of Tzajalchén. But her patients all know how to get there. Her neighbors report that almost every day during the COVID-19 pandemic, there were more than six pregnant women waiting to be cared for by this traditional midwife.
“I assisted 413 births,” she says, smiling. Her husband, Pedro Guzmán, jokes: “The doctors were jealous.” Through her garden, where she dries corn in the sun and grows medicinal plants, such as muicle leaves for anemia during pregnancy, pregnant women come by one after the other.
Lucía performs monthly check-ups, vitamins injections, and belly massages to place the fetus in the correct position for birth. When she has time, she weaves wool bags with traditional Tzeltal patterns, kneads corn flour for tortillas, braids her hair, reads the Bible, and teaches her craft to her daughter-in-law, María Esther.
Giving birth
It’s now 5:45 in the morning. The cicadas have broken the silence in the mountains. The cracks in the walls, made of wooden boards, let the first rays of sunlight filter into the delivery room. Pedro waits outside next to a sack of coffee beans.
Inside, Lucía massages the belly of María Guadalupe and checks her cervical dilation: “She is 5 cm dilated.” She takes the fetal heart rate with a sonar that an organization gave her, talks in her own Mayan language and waits for the contractions.
It is the eighth birth for 32-year-old María Guadalupe. Her first seven children, the eldest being 15 years old, were born with the help of her community midwife, squatting in the kitchen of her own house. This time, the gynecologist from San Cristóbal de las Casas, the closest town, detected a hernia in her belly, which is why she turned to Lucía.
There is a lack of recognition of midwives’ work by the State and health professionals.
Lucía can administer an IV, knows how to apply oxytocin and allows what is called humanized birth, when the pregnant women choose the position in which they give birth. “With the other midwife I had to make a lot of physical effort, I wanted to lie down, that’s why we came here,” María Guadalupe explains in Spanish.
With dawn comes the sound of a loudspeaker announcing Sunday mass. María Guadalupe begins to gasp, but she does not shed a tear. María Guadalupe’s mother covers her face with a thin red embroidered cloth and never taking her eyes off her daughter’s body.
Outside, the rooster crows. “Breathe, breathe,” Lucía tells María Guadalupe in the Tzeltal language. “Push, push” she repeats in a gentle voice. The turkeys crow. On the cot, a discrete movement, then a low moan breaks the silence, and the first cry of the newborn. The girl cries. The mother and grandmother laugh.
Fear of hospitals
Lucía writes down the exact time of birth in her notebook: 6:20 a.m. The sounds from outside do not reach the inside of the room, where the baby girl monopolizes all the noise. The midwife waits for the placenta to come out and checks that there are no remains of flesh inside it. “That would cause a lot of bleeding,” she explains.
Unlike medical professionals, she waits before cutting the umbilical cord. She lifts the accumulation of blood and skin as if it was a serum bag and lets every last drop of maroon fluid go down to enter through the navel of the newborn: “This way, she will grow healthier.”
Then, she wraps the girl in a blanket and places her on María Guadalupe’s chest “so that she recognizes her scent.” Skin-to-skin contact. She recommends not bathing her until the next day and explains that the first colostrum, or first milk, is the food with the most vitamins. The father returns with his arms loaded with blankets and baby clothes. “I’m just cold, not in pain,” the veteran mother says.
“Do you want more children?”
“Well yes, because we don’t have the money to pay for [contraceptive] medicines, and I don’t want to have surgery. I’m scared of hospitals.”
In rural areas, a cornfield is enough to feed many mouths in a good harvest year, but families do not have enough for gasoline or medicine. Within the green walls of the precarious regional hospitals, surrounded by white coats smelling of ethyl alcohol, women like María Guadalupe do not feel safe or supported.
“They yell at us, they insult us for being indigenous.” It is a story that the midwives who care for hundreds of indigenous women every day know well. The wounded cry of these women crosses Mexico from north to south. According to the latest National Survey on the Dynamics of Relationships in Homes (ENDIREH), from 2021, three out of 10 Mexican women experience obstetric violence — especially poor, indigenous and peasant women who often do not even speak the same language as the caregivers.
On the table, Lucía fills out the birth certificate with the logo of the Nich Ixim Midwives Movement. “I didn’t go to school, but look, I know how to write. I learned to read in church.” She writes down the place of birth, the weight and height of the girl: 3.5 kilograms (7.7 pounds) and 48 centimeters (18.9 inches). She takes the imprint of her tiny feet and the name of her parents. She is the 108th birth of the year 2023, “and April is not over yet,” Lucía notes.
A fight for recognition
A year later, in early May 2024, Lucía says over the phone that she has already attended 105 births. With the first light of day, another pregnant woman arrives at her door asking for a vitamin injection. She is the most sought-after midwife in the Chiapas Highlands. She helps bring life every day, and perhaps that’s why her smile never leaves her face.
On March 26, the reform to Mexico’s General Health Law – a proposal from the Morena party of outgoing President Andrés Manuel López Obrador – came into force, allowing traditional midwives to issue birth certificates: “The birth certificate will be issued by medical professionals, traditional midwives and people authorized to do so by the competent health authority.”
It’s a small recognition for midwives, but also a way to fulfill the right to identity of children: In this region, thousands of children are not registered or documented because they were born in the arms of a midwife.
For Ofelia Pérez, a Tsotsil speaker from Chenalhó and leader of the Nich Ixim Midwives Movement – which means “corn flower,” – it was a bittersweet victory. Her organization has been fighting institutions since 2019 for the recognition of this birth certificate. The same one used by midwives like Lucía Girón and more than 650 traditional and independent midwives constituting the organization.
The situation today is terrible. I didn’t feel as much discrimination from doctors before.
“Still today we believe there is a lack of recognition of our work by the State and health professionals,” she points out from her office and midwife school in San Cristóbal de las Casas.
Like many indigenous Mayan women, Ofelia inherited her role from her ancestors. She became professional not only through practice and workshops with other midwives from southern Mexico and Guatemala, but also thanks to the trust placed in her by hundreds of pregnant women.
She rejects the mandatory professionalization of Mexican institutions, which she believes is not fair for her colleagues: “Many do not have the financial resources to study.” She also believes respect for their indigenous identities, cultures and knowledge should prevail over academic titles. Nevertheless, she recognizes a common objective with health personnel: “To serve women of reproductive age in maternal and neonatal health to contribute to a decrease in maternal mortality.”
They do this work in exchange for a few pesos and voluntary contributions. Ofelia says they work 24 hours a day in the communities, where often there are neither doctors nor supplies. Only midwives and doctors can deal with emergencies. “When there is an emergency or complication, midwives always refer patients to hospitals, but they have to put up with many obstacles,” Ofelia says.
Resisting stigmatization
The World Health Organization (WHO) noted in 2019 that midwives can prevent 80% of maternal, neonatal and intrauterine deaths when they have adequate training to care for obstetric emergencies. Yet, “the State still does not recognize traditional midwifery, although it is part of indigenous peoples’ rights,” Ofelia says. She also points out that many women in the community suffer intimidation by health personnel not to go to midwives.
In Mexico, professional midwifery was promoted by the Government in 1940, with the incorporation of midwives as part of regular staff for obstetric care in the Mexican Social Security Institute (IMSS). In the past decade, their work has been replaced and displaced by the medicalization and institutionalization of hospital births.
“The situation today is terrible,” says Juana Cruz, a proud traditional midwife and indigenous leader in Chamula. “I didn’t feel as much discrimination from doctors when we accompanied a patient to the hospital before.”
Last year, the United Nations Population Fund (UNFPA) also said that Mexico has the opportunity to make a change in favour of women and their babies by “recognising the competencies, leadership, comprehensive care centered on women” for which “innovation in the organization of health services and midwifery care spaces” is needed.
I will continue fighting for the women who come to me.
But the contempt for this ancestral profession, which is predominantly female, and the persecution of midwives is something that all the interviewed midwives suffer from on a daily basis. This is reflected in the Nich Ixim organization’s communications.
“They tell us that we are the cause of maternal deaths. They do not accept our patients in hospitals when we refer them due to complications,” says Lucía Méndez, a 32-year-old traditional midwife, originally from the town of Las Rosas.
According to the National Institute of Statistics and Geography (INEGI), in Mexico, 87.8% of births happen in hospital centers, and less than 5% by midwifery, with the Chiapas state registering the highest number of these births. Nationwide, in 2022, more than 88,000 babies were born with the help of midwives and doulas.
Resisting stigmatization, midwives continue to organize to provide safe and sustained care to the women who come to them. “No matter how much they discriminate against me and attack me, I will continue fighting for the women who come to me,” Juana says, “It is thanks to the women who give us that experience, and we learn as we go.”
Untold obstetric violence
According to the 2021 National Survey on the Dynamics of Relationships in Homes (ENDIREH), obstetric violence only occurs in three out of every 100 births attended by a midwife (compared to three in 10 overall births). In the Chiapas state, for example, almost 19% of women have suffered some type of abuse during pregnancy, childbirth or puerperium by health personnel.
Ofelia remembers the case of a migrant woman who came to her for fear of being deported if she went to a hospital. Her son did not have his birth certificate recognized until he was 3 years old.
Lucía explains how, during the birth of her first child, the doctor who treated her performed a cut – or episiotomy – without her consent: “I questioned it then but never saw that doctor in the room again.” Or the case of a colleague who died after a doctor forgot to remove the gauze pads that used to clean the inside of her uterus.
Stories of violence are told by dozens, often in whispers. Both Ofelia and Lucía have had cases of indigenous women being forcibly sterilized, but records of complaints are scarce. And complaint processes “can last for years and require a lot of financial resources,” says Anahí Rodríguez, advocacy officer for the feminist organization GIRE (Information Group on Chosen Reproduction).
For the UN, “forced sterilisation is an unacceptable practice with lifelong consequences on the physical and mental integrity of girls and young women with disabilities that must be immediately eradicated and criminalised.” Frequently, women who suffer from it do not have the resources or the necessary education to report it.
Rodríguez says that “there is an intersectionality related to social status, the economic background and the identification of people as indigenous” in the access to a humanized birth within the medical system. Speaking out loud is a privilege that many women in rural and isolated communities do not enjoy.
A C-section epidemic
Another concern for midwives and international health organizations is the brutal epidemic of cesarean sections in Mexico. The WHO recommends that they do not exceed 15% of annual births and recognizes that midwifery helps reduce cesarean sections and unnecessary interventions during childbirth. In 2023, the percentage of births by c-section in Mexico reached 54%, according to the National Center for Gender Equity and Reproductive Health, making it the third country in Latin America with the highest number of these interventions.
The job benefits in this profession are also scarce. “In the future, I would like to see pregnant women given quality care. I would like to see the government giving some incentive to experienced midwives and recognition of their work and contribution to the community,” Lucía says, adding that midwives also help many women with their right to abortion and inform their patients about sexual and reproductive rights.
I was born from a midwife, and I am going to die a midwife.
Erasing the practice of midwifery through legislation seems impossible, but the fear persists. In Mexico there are almost 16,000 midwives, which is an underrepresentation because many are not registered.
At the entrance to María José’s house, a large sign reads: “We attend births.” At 86, she is possibly one of the longest-serving urban midwives. Inside, María José and Juana talk about their work.
“I want them to let us continue practicing midwifery, to respect us, so we don’t have to hide to provide care,” Juana says. Laughing, surrounded by medical supplies, figures of the virgin and saints, María José says: “I was born from a midwife, and I am going to die a midwife.”
