Abstract
Luna Maya is a Mexican NGO that operates two full-scope midwifery centers in Mexico City and Chiapas, Mexico, providing woman-centered, culturally appropriate midwifery model maternity care on a sliding cost scale. The COVID-19 health crisis has made it necessary for Luna Maya to quickly incorporate safety protocols for out-of-hospital maternity care. Yet many of the emerging guidelines on maternity care have focused on high-income and hospital settings; there are no specific guidelines for such care in out-of-hospital settings in low- and middle-income countries. Thus we have had to create our own, based on best available and emerging evidence. In this article, we describe the guidelines and protocols we have created in response to COVID-19, the international evidence and recommendations on which we base them, and precisely how we carry them out in practice. We also present and analyze the results of qualitative interviews we conducted for this article with eight of our midwives and eight of our midwifery clients. These interviews reveal the tremendous stresses both midwives and pregnant and birthing women are experiencing as a result of the pandemic, their creative adaptations, and the structural flaws, deficiencies, and inequities of the Mexican healthcare system. The article also addresses Luna Maya’s ongoing challenges in continuing to provide care completely outside of governmental support and in difficult economic times, and demonstrates the extreme need for improvements in the Mexican system of maternity care and for full integration of community-based midwives and out-of-hospital birth.
Highlights
PLACING CATASTROPHE ON TOP OF A BROKEN MATERNAL HEALTHCARE SYSTEMThe COVID-19 pandemic has highlighted health inequities and systemic gaps and failures (Bambra et al, 2020)
Luna Maya midwives are on staff and provide midwifery care assisted by midwifery students who are learning the Midwifery Model of Care through clinical apprenticeship
As experts in physiologic birth and sexual and reproductive health, midwives understand that these processes work best when they are spontaneous and surrounded by a calm and supportive environment
Summary
The COVID-19 pandemic has highlighted health inequities and systemic gaps and failures (Bambra et al, 2020). Women at Luna Maya can choose to birth either at home or at the midwifery center; all other care is provided in the two centers. Midwives have been recognized as specialists in women’s sexual and reproductive health (Sakala and Newburn, 2014) and continue to be on the frontlines of providing care during the COVID-19 pandemic, which has exacerbated existing tensions and failures in full access to safe motherhood as seen through a rights-based perspective (Jolivet et al, 2020). For over 15 years, Luna Maya has provided a safe ground for women to choose safe and respectful birthing options in a country where cesarean rates exceed 50%, and over 30% of women state that they have experienced obstetric violence (Castro and Frías, 2019). We analyze the qualitative interviews we carried out with Luna Maya midwives and clients describing the impact of COVID19 on their perceptions of choices and options for safe and respectful birth
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