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COLOMBIA: Midwives Seek Legal Recognition, Respect

Helda Martínez

BOGOTÁ, Jul 13 2010 (IPS) - In Colombia, western medicine has nearly succeeded in pushing midwives — “parteras” or “comadronas,” as they are known in Spanish — out of existence. But some tenacious practitioners are pushing for a law to formalise the role of midwife as a health worker.

“Through 2009 and so far in 2010, there have been no deaths of women attended by a member of the United Midwives of the Pacific Association,” said Liceth Quiñones, 22, who works as a midwife in Buenaventura, the principal Colombian port on the Pacific coast.

Daughter of 60-year-old midwife Rosmilda Quiñones, Liceth was three in 1991 when her mother founded the association, which she still heads. With the acronym ASOPARUPA, it has 250 members in the western departments (provinces) of Chocó, Valle, Cauca and Nariño.

At six, Liceth was already assisting her mother. “Midwifery is learned through the oral tradition and through practice,” she explained to IPS. When she was 13 she recognised when a placenta did not come out completely and knew it was urgent to get the mother and newborn to the hospital.

“Today we don’t work with anyone who hasn’t had previous medical check- ups. And we are clear that any complication must be dealt with by a specialist,” she said.

The 1,500 midwives in Colombia, according to a 2008 census conducted by the Valle Health Superintendent, are not certified or authorised to assist in hospital births.

Formal training is limited to first-aid workshops or other similar courses offered by the Red Cross and a national apprenticeship service.

They have learned to overcome the jungle distances of Valle and Chocó, where transportation is nearly all by river, which means dangers of floods and snakes. “We travel at any hour, with total commitment and the certainty that nobody survives economically from this job,” said Quiñones.

She makes her living with a centre for alternative medicine that provides services in bio-energetics and other techniques, and where she practices what she learned in professional nursing — a course of studies she did not finish due to lack of resources, later downgrading to nursing assistant.

Quiñones also brings in knowledge acquired in Mexico, and from midwives from Brazil, as well as from contacts and apprenticeships with midwives from the other corners of the world.

These women are convinced that natural birth is the most effective, but they do not reject modern western medicine. The doctors “don’t accept us in their hospitals, but we accept them,” she said.

The path to formalising midwifery in obstetric services is a midwifery law that would regulate it as a professional practice. The Senate approved the bill in 2009, and should be part of the agenda of the new legislature, to be sworn in Jul. 20.

Dilian Francisca Toro, a physician from Valle, now a senator for the conservative governing Social National Unity Party, presented the proposed law.

“The real work, the basis of this law, was done by Doña Rosmilda (Quiñones), Liceth and many women,” said Bogotá midwife Alejandra Montes, who holds degrees in law, political science and philosophy, and is now studying to be a nurse’s assistant.

In 2008, Montes founded the non-governmental Association of Urban Midwives (ARTEMISA), after spending seven years in different regions of Colombia with indigenous and Afro-Colombian peoples.

Midwives exist in various forms across Latin American indigenous cultures, as well as in the African and European cultures represented in the region.

According to the Ministry of Social Protection, the maternal mortality rate in Colombia is 75 deaths per 100,000 live births. In the United States, the rate is 13.3, according to figures from 2006, worse than the 1987 rate of 6.6 per 100,000. The increased maternal mortality can be linked to the crisis of the U.S. health system. Midwives in that country are largely marginalised from institutional obstetric services.

“In France, England, Germany, Canada… midwives are permitted and needed in the births under optimal conditions,” said Montes.

In Argentina and Uruguay, the midwife is a university-trained professional who is integrated into the obstetric team of any hospital.

Seeking a deeper understanding of midwifery, Montes lived several months in Buenaventura “to observe them and to learn,” for her role as a university professor and researcher.

She noted that “70 percent of births with midwives are completely healthy, and the remaining 30 percent present difficulties that are inherent to the birth itself.” Most are detected in time for the necessary medical specialist to be involved.

“With each birth we have greater control” over the situation, said Quiñones.

Working with a midwife is an integral process that should begin during the first month of pregnancy and continue after the birth.

But in the cities, midwifery is seen as something “dangerous, dirty,” and prejudice is fed by ideas that it is “witchcraft, or is only needed in the absence of doctors,” Quiñones said.

However, if the law is passed, the companies that manage the medical services provided by the government will begin to utilise midwives because “they have the infrastructure established, and it will mean more revenues,” she surmised.

An option half-way between traditional midwifery and hospitalisation for birth is being explored in Bogotá by the private Procrear Foundation, led by physician Mauricio Espinosa.

The Foundation offers underwater birth services, with the support of a midwife and the supervision of Espinosa.

“It’s comfortable, warm, and gives you an immense sensation of freedom,” said Carolina Zuluaga, remembering the birth of her son Federico two and a half years ago.

“Juan, my husband, helped me to push, cut the umbilical cord, and we saved the placenta for eight months before returning it to the universe in thanks for our son,” she said.