Parteria profesional y autorregulacion professional midwifery & self-regulation: report on an International Conference hosted by the CASA Professional Midwifery School, San Miguel de Allende, Guanajuato, Mexico in June 2002

International Midwifery, May-June, 2003

Executive summary

Over decades now, data produced from prospective and other studies has pointed up that midwives provide safe, low intervention and economical care in multiple settings. In 1997, the Safe Motherhood Inter-Agency Group (IAG) carded out a technical consultation to review and articulate the lessons learned since the inauguration of the global Safe Motherhood Initiative in 1987. It was declared that the most efficient means to prevent almost all maternal deaths is to ensure skilled care during childbirth; defining skilled care as care by a professional health worker such as a midwife, nurse, or doctor who possesses midwifery skills. Yet, numerous countries, especially in the developing world, do not have national programs geared to training midwives and including them in the public health system. In fact, there is a decreasing number of midwives and nurses worldwide, which is negatively affecting an already overtaxed global health care system.

In response to this situation the CASA Professional Midwifery School, a national pilot project in Mexico dedicated to producing new midwives who combine the best of traditional midwifery practices with up-to-date medical knowledge, hosted an international conference in June 2002. The aim of the conference was to inspire and encourage North American and Latin American countries to consider the formation and certification of midwives and the incorporation of the midwifery model of care into their individual public health systems. CASA spearheaded the organising committee and is grateful to the United States Agency for International Development, the principal sponsor of the conference.

Over 170 people from 13 countries participated, the majority from Mexico and Central America; 50% of the participants from governmental agencies, 30% from non-governmental and 20% from the general public with experience in professional midwifery or related fields. There was enthusiastic representation from national institutions and international organizations such as WHO, ICM, Midwife Alliance of North America, American College of Nurse Midwives and the International Federation of Gynecology and Obstetrics. Importantly, traditional midwives were also included in the conference both as participants and speakers.

Dr. Lourdes Quintanilla, Director of Reproductive Health for the National Health Ministry in Mexico, representing Dr. Julio Frenk Mora, Mexico's national health minister, opened the three-and-a-half day conference. Following her remarks, the first day continued with presentations from anthropo-logists, sociologists, and historians who spoke about core issues and conflicts in midwifery and provided a global tour of midwifery education, status, practice and identity. Traditional midwives also shared the podium, addressing their practices, traditions and struggles in the post-modern world.

During the conference, numerous models of midwifery education and practice were presented. Experts updated participants on the most recent epidemiological research and analysis documenting midwifery as key to the safest maternity care. Examples were given from countries in which midwives have gained professional status and currently work in collaboration with their governments.

The concept of competency-based education and certification was expounded. There was debate as to what is the most appropriate preparation for new midwives and what constitutes professionalism. Some contended that professionalism can only be achieved within a university context. Others asserted that multiple routes of education can lead to competent practitioners. Others stressed that when setting up educational programs, both the private sector and government need to take into consideration education levels of young women, especially those who reside in rural villages. In many parts of the world including Mexico and many countries south of Mexico, the educational levels for women are low.

While there was debate, there was also a general consensus that there is a great need for culturally appropriate, middle level health providers in rural areas. There was also a widespread agreement that all women, regardless of geography, have the right to the reproductive health care of their choice, including the midwifery model.

After the conference, the participants returned to their respective countries well-informed about how midwifery can be an important part of the interdisciplinary solution to serious problems that include but certainly are not limited to unacceptably high rates of maternal mortality and morbidity, the lack of culturally appropriate care, especially in rural areas, and high and medically unjustified rates of cesarean that financially drain an already overtaxed health systems.

All participants of the conference were also advised that a final report on the conference would be forthcoming, that the CASA Professional Midwifery School staff is available to provide technical assistance to others interested in starting midwifery schools and programs and that the CASA Professional Midwifery School will consider applications to its program from prospective students throughout Mexico, as well as from countries south of Mexico. The CASA Professional Midwifery School currently has students from 9 states throughout the Mexican Republic, all of whom are on scholarships.