Margarita Perez Jimenez and Martha Domínguez López can both say their lives changed at the age of 14. For Jimenez, that was the year she began working as a traditional midwife in Chiapas, Mexico. For López, it was when she became a single mother.
The two women met around May 2017, when Jimenez was 67 years old and had delivered, she says, at least 5,000 babies, most of them within a mud brick, zinc-roofed shack behind her home in the rural town of Francisco Madero. López could have been among the women who delivered in these modest surroundings, not far from roaming chickens and a black-and-white kitten.
Except at 14, López was a particularly young expectant mother and, therefore, more likely to experience complications during delivery. It was with this in mind that Jimenez and López’s family turned to outside help.
After carrying her pregnancy to full term, López gave birth in Casa Materna, a maternal health center supported by Compañeros En Salud, as Partners In Health is known in Mexico.
Since the facility opened in May 2017, more than 360 women have given birth at the hands of doctors and OB/GYN nurses who staff the clinic 12 hours a day, seven days a week. On average, 280 women arrive each month for urgent care and exams, after being referred from the neighbouring health centers in Jaltenango and surrounding communities.
Since the facility’s early days, PIH staff have seen an increase in the number of women choosing to come to the Casa for prenatal services and, when the time comes, to deliver. The trend is reassuring, especially in Chiapas, a state where the rate of maternal mortality is among the highest in Mexico—49 per 100,000 women.
Historically, expectant mothers living in the coffee-growing regions of the Sierra Madre visit a traditional midwife for their prenatal care and for help with labour and delivery. When pregnancies are normal and labour is uncomplicated, such a choice is low-risk. But it can be hard to predict whether labour will be complicated. When it becomes so unexpectedly, women and their newborns can be in grave danger, especially when the nearest hospital may be a three-hour drive over treacherous, mountainside roads.
PIH leadership in Mexico knew there had to be a better way to ensure expectant mothers had access to quality care. In late 2016, staff began recruiting and training 34 community health workers specialized in maternal care across the 10 communities PIH serves in rural Chiapas. These women each serve a handful of expectant mothers in their neighbourhoods by answering their questions, counselling them on breastfeeding and nutrition, and accompanying them on prenatal visits at nearby PIH-supported public clinics.
When due dates approach, they help patients create a birth plan and advise them to travel in advance to Jaltenango, where they stay near the Casa Materna to await labour—receiving vouchers for meals and free lodging throughout their stay.
None of this is meant to undercut the role of traditional midwives. PIH-supported clinicians partner with these well-trusted women as valuable local resources and allies who can bridge the gap between custom and modern medicine. The organization provides them with birth kits—including sterile gloves and umbilical tape, gauze, and alcohol—and training on how to identify at-risk pregnancies. Midwives are encouraged to refer patients to the Casa Materna should complications arise, and to support them throughout labour and delivery at the facility.
Alma Rosa Valentin Martinez (center), an obstetrics nurse fulfilling her social service year with PIH in Mexico at Casa Materna, takes the blood pressure of Gloriena Elizabeth Roblero Mendoza, a 35-year-old mother pregnant with her fifth child. Her 4-year-old son, Angel Ronay Roblero Roblero, plays with a birthing ball throughout the exam.
Cecille Joan Avila / Partners In Health
This entire system of maternal health care was just getting in place in the spring of 2017, when López arrived at her aunt’s home in Francisco Madero. At 14, she was four months pregnant, abandoned by her partner, and fleeing her abusive father.
Her aunt, Atanacia Argeta Idalgo, lived on a small farm with her husband and four children a 10-minute walk from the center of town. She welcomed López and took her to see Jimenez, whose arthritic hands had delivered all of her children and had even ushered her into the world, 32 years ago.
Jimenez, a grandmotherly woman with silver-streaked hair and a weathered, round face, gently massaged López’s abdomen to feel the baby’s position. A girl, she said. But how could she be sure?
“The girls are soft; and the boys are hard,” Jimenez said matter-of-factly.
She knew what she was talking about. When Idalgo took her niece to Casa Materna for her routine six-month ultrasound to determine the baby’s sex, staff there confirmed the midwife’s assessment: girl.
Every several weeks, López walked up the hill into town to visit Jimenez. The teenager grew to trust the midwife’s touch and warm presence. Her pregnancy, thankfully, had been easy—no major aches and pains. She’d had low blood pressure, but that seemed to have subsided over the course of the pregnancy.
So when her due date approached and her abdomen clenched at dawn with early contractions, López and her aunt headed first to Jimenez’s house. The midwife examined the young mother and determined that she still had hours to go, guessing the baby would arrive by early afternoon.
But Idalgo hesitated returning home to wait, seeing her niece racked with pain. Instead, she drove her 15 minutes to the Casa Materna for a check-up. Staff there examined López and repeated the midwife’s prediction; the young mother still had hours to go and could continue labouring at home.
Idalgo knew López only felt comfortable with Jimenez by her side. Yet she worried that, given her niece’s age, serious complications could arise. The midwife had equal concerns.
So Idalgo talked to Casa Materna staff about the teen’s preference for Jimenez. Without flinching, the attending nurse said, “Well, if she has confidence in her, bring her along.”
That’s exactly what they did. Later on the morning of October 24, López’s labour had progressed and Jimenez thought it was time to return to the Casa Materna. The midwife, aunt, and young mother loaded into the car and sped back to Jaltenango. Staff welcomed them, and one of the nurses attended to their every need throughout their stay.
Around 2 p.m., with Casa Materna staff waiting in the wings, Jimenez helped López deliver a healthy, 7 lb. baby girl with a head full of hair.
“Thanks be to God, she didn’t suffer much,” Jimenez said of her patient.
Casa Materna staff congratulated the women, and informed Jimenez that she was the first traditional midwife to deliver her patient there. It was a major win—proving that local expertise can partner with modern medicine to bring quality maternal health care to women living in rural Chiapas.
Two weeks later, Jimenez sat in the shade of Idalgo’s patio, next to López and her yet-to-be-named infant daughter. The young mother, not one for words, glowed with pride.
Jimenez said Casa Materna staff had invited her to return with her patients. When asked if she would recommend the facility’s services to other women, Jimenez’s answer was easy: “Adelante!” And she would be right by their side.
Margarita Perez Jimenez gently hands back a newborn baby girl to her young mother, Martha Domínguez López, whom the traditional midwife helped deliver at Casa Materna in Jaltenango, Mexico.
Cecille Joan Avila / Partners In Health
