In Mexico, Empowering Mothers During Childbirth

Years later, Estefanía Monterrosas still remembers the girl.

How she came in the middle of the night. How she came alone. How she had crossed the border from Guatemala to Mexico with little more than identity documents, stating her age was 18—documents that turned out to be her sister’s.

The girl was only 15. She had run away from home. And no one in her family, but her sister, knew she was pregnant.

Monterrosas was on duty at Casa Materna that night. She had never seen the girl before. But she recognized her.

“I was a teenage mother,” says Monterrosas. “So I kind of understood and felt everything she felt. No woman should have to go through what I went through.”

Casa Materna is the maternal health center at the community hospital in Jaltenango, a town in the rural, coffee-growing Sierra Madre region of Chiapas, Mexico. Compañeros En Salud, as Partners In Health is known locally, has worked there for more than a decade in partnership with the Ministry of Health, providing medical care and social support to thousands of families.

That night, Monterrosas, then a first-year clinician, recalls watching in awe as nurses and midwives sprang into action, staying by the girl’s side for hours and helping her give birth safely.

It’s an experience that has stuck with Monterrosas through the years. And it ignited a passion for respectful childbirth that she has carried with her to this day. Now, as clinical supervisor of Casa Materna, Monterrosas aims to instill that passion in her team of nurses and midwives every day.

“Casa Materna is an example that things can be done differently,” she says. “In the end, it is possible.”

Respectful Childbirth

Since 2016, Casa Materna has helped more than 821 women give birth safely and has provided more than 10,000 prenatal consultations. But safe deliveries weren’t always so achievable in Chiapas.

Before the maternal health center opened its doors, women in labor in the rural, mountainous communities of the Sierra Madre region often had nowhere to go if they wanted a facility-based delivery, even after traveling for hours to Jaltenango, where the community hospital lacked the space to accommodate them.

That challenge set in motion a series of talks between Compañeros En Salud and the Ministry of Health about expanding the community hospital’s maternal ward into a maternal health center, which would provide the space, staff, and resources for women to give birth safely.

In 2016, Casa Materna was born.

“I remember it now and it makes me very nostalgic,” says Monterrosas. “It was always something we had dreamed of.”

At Casa Materna, Compañeros En Salud provides care for women at all stages of pregnancy, connecting new and expectant mothers with medical care, including consultations and tests, and social support, such as free housing and transportation. Staff includes traditional midwives, since many women in Chiapas have historically chosen to give birth at home and feel more comfortable with midwives. At every stage of care, clinicians put the mother and her needs at the center.

Since its earliest days, Casa Materna has been guided by a model of respectful childbirth, which recognizes the woman’s autonomy to make informed decisions about her body and birthing process—a stark contrast to the experiences of many women in labor in hospitals throughout Mexico, where childbirth is viewed through a strictly medical lens and women often aren’t listened to. Instead of assuming to know what is best, clinicians at Casa Materna educate the woman about her options, ask what she would prefer, and then act accordingly.

Those decisions include everything from what birthing position she would prefer to whom she would like present in the delivery room, including any family members. Additionally, following birth, newborns are immediately held to the mother to facilitate bonding between mother and child.

“At Casa Materna, we try to make sure that women have the information they need, so they can make decisions,” says Monterrosas. “We fully believe that labor should evolve according to each body and each woman.”

‘I Leave Here Feeling Alive’

Casa Materna is not only proving that respectful childbirth is possible in Chiapas—it’s also proving that seasoned doctors aren’t essential to delivering it.

Most staff at Casa Materna are first-year clinicians—recent graduates completing their mandatory year of social service with Compañeros En Salud—and traditional midwives. The model has shown what’s possible for maternal health services in rural contexts, where experienced doctors are often hard to find.

Just 27% of deliveries at Casa Materna and the community hospital were supervised by first-year clinicians in the center’s second year of operation. But by December 2020, 86% of all deliveries were supervised by first-year clinicians, demonstrating that, even with limited staff and resources, lives can be saved and new life, welcomed into the world.

María Avendaño, a recent graduate in nursing, is one of the first-year clinicians currently completing her year of social service at Casa Materna.

“Despite having only a little time here, I feel like I’ve learned a lot,” she says. “I’ve learned a lot about dignified care. I’ve also learned how to engage with people in the community.”

That learning cuts both ways.

“I think that Casa Materna is a safe space for all of us who are dedicated to the care of pregnant women,” says Monterrosas. “We always learn something new from everyone.”

Monterrosas spends her days learning. Before she starts her shifts, she knows which women are in labor, which are staying in town as they approach their due date, and which are waiting for a referral to an advanced hospital.

It’s a process that has become more arduous lately, amid COVID-19. As the pandemic has surged in Mexico, filling ICU beds and consuming already scarce resources, Monterrosas has had to fight to get her patients with pregnancy complications access to advanced hospitals—a journey that takes several hours and depends on the availability of Compañeros En Salud’s only ambulance, which is also used to transport COVID-19 patients.

Amid all the uncertainty, Monterrosas does what she can to stay grounded—leading her team by example and continuing to advocate for the respectful care at the heart of Casa Materna.

“There are days that are heavier than others. There are days that are calmer than others,” she says. “But at the end of the day, I leave here [feeling] alive.”