Obstetrics in a Time of Violence: Mexican Midwives Critique Routine Hospital Practices

Abstract

Mexican midwives have long taken part in a broader Latin American trend to promote "humanized birth" as an alternative to medicalized interventions in hospital obstetrics. As midwives begin to regain authority in reproductive health and work within hospital units, they come to see the issue not as one of mere medicalization but of violence and violation. Based on ethnographic fieldwork with midwives from across Mexico during a time of widespread social violence, my research examines an emergent critique of hospital birth as a site of what is being called violencia obstétrica (obstetric violence). In this critique, women are discussed as victims of explicit abuse by hospital staff and by the broader health care infrastructures. By reframing obstetric practices as violent-as opposed to medicalized-these midwives seek to situate their concerns about women's health care in Mexico within broader regional discussions about violence, gender, and inequality.

Delivery practices and care experience during implementation of an adapted safe childbirth checklist and respectful care program in Chiapas, Mexico

“…Disrespect and abuse during delivery at a health facility have gained global attention as critical reasons why women might fear, or do not attend, facilities for childbirth care . Indeed, the term ‘obstetric violence’ has been used to describe various forms of mistreatment among women during childbirth in Venezuela and Mexico, among other Latin American countries . In Mexico, obstetric violence includes health workers’ microaggressions toward women in labor, as well as unnecessary medical interventions such as routine episiotomy, application of fundal pressure to hasten the second stage of labor, and cesarean delivery without medical indication …”

A Tale of Three Midwives: Inconsistent Policies and the Marginalization of Midwifery in Mexico

“…Lydia Dixon has worked with midwives in Mexico since 2002, and conducted seventeen months of ethnographic research on midwifery education in San Miguel de Allende, Pátzcuaro, and Oaxaca City between 2009 and 2012. In this article she draws from her work with midwives trained at CASA, who refer to themselves as parteras profesionales-professional midwives (Davis-Floyd 2001;Dixon 2015). Mounia El Kotni conducted thirteen months of ethnographic fieldwork in Chiapas, between 2013 and 2015, on the impact of public health policies on traditional indigenous midwives who acquire their knowledge through various processes, including dreams and personal birth experiences.…”

“…While these schools provide students with an official license to practice as professional midwives in state hospitals and clinics, their graduates represent only a fraction of the country's practicing midwives. 4 These professional midwives still struggle-in clinical encounters alongside physicians, as well as in political discussions over broader maternal health care reform-to achieve authority in a health care system that still sees birth as the domain of obstetricians (Dixon 2015).…”

Interseccionalidades de género y violencias obstétricas.

“…• Saber tradicional-popular vs. el saber biomédico: el control extremo del proceso de embarazo, parto y crianza. Extremadamente documentado en literatura (Menéndez, 1994), también en los temas de partería (Zacher-Dixon, 2015), podemos sintetizarlo brevemente a partir de la idea de que el Modelo Médico Hegemónico (MMH) impone su concepto de profesionalización a los otros saberes médicos. El MMH se define a partir de las características de objetividad, reduccionismo, experimentalismo, determinismo, tecnicismo y biologicismo.…”