Mexican Midwife Improves Quality of Care for Mothers

By providing compassionate and culturally appropriate care to women throughout their reproductive life, trained and supported midwives are critical to closing the gaps in human resources for health and helping to reduce maternal and newborn deaths. Gloria Flores, a licensed nurse and perinatal specialist from Morelos state, Mexico, is working to improve the quality of care moms and babies receive and to help mainstream professional midwifery practice at the primary health care level.

With the support of the John D. and Catherine T. MacArthur Foundation, the FCI Program of MSH is helping to build the policy and advocacy skills of midwives like Gloria Flores, further equipping them to become advocates and leaders in the health system. The International Confederation of Midwives (ICM) interviewed Flores to about some of the challenges she faces in her work and how she’s working to change the status quo around midwifery practice in Mexico.

Read Gloria’s story in Spanish, first published by ICM.   

This interview has been translated from Spanish and adapted for clarity and length.

Hi Gloria, could you tell me a bit about how you entered the world of midwifery?

My main motivation came while working at a general hospital in Morelos state, Mexico. When I noticed how pregnant women were being treated when they arrived, the care they received, it depressed me. I wanted to get more education and improve the way they were cared for so I started studying to become a professional midwife while still working at that hospital.

What would you say impassions you the most about your job?

Everything! (laughs) When a patient comes to me with her swollen belly, I start getting excited about giving her the best care possible, and then when I hear her story, this passion only grows. Once she leaves, her gratitude makes me very happy as well. But that one moment, the moment of birth, is an incredible experience. When the baby first cries and makes a sound, then sees their mother’s face, that is the most beautiful and passionate moment for me. We do, however, want these moments to be experienced in better environments.

What would you say are some main barriers to performing your job well?

A main barrier is infrastructure. The hospitals where I work have too great a demand for the resources available. In the ward I work in, I have six beds for patients, which is exceeded every day. There are barely curtains dividing patients, and they are all in the same room. This is a significant obstacle in providing individualized, personal care.

How are you working on improving the birth experience for these women?  

Currently, we’re implementing a standard of care, in accordance with other organizations and international standards, called Posada AME, [a health care delivery model] which is aimed at giving mothers the attention they deserve and advocating in this initiative for women to be able to give birth in a humanized setting. Providing warm clothes, a warm environment, calming music, a soothing bath and a private space with enough room for one of their loved ones to be present – these are our objectives. All my colleagues are extremely excited about continuing to implement this initiative in our state.

What are you doing to help to implement these changes?

We have had interviews to assess needs, reach the relevant people and have already engaged with the Health Minister to assess how the Ministry of Health would benefit from implementing these changes in order to influence and encourage them to make the investments necessary to make this change happen. We want this project to be completed in the next six months, working across hospitals and with fellow midwives.

I also see a positive change in the future as the law is changing. Midwives and related health workers are being considered in the law which have also enabled us to create networks, making the most of technology as well, to support one another and have our voice heard. In conjunction with the MacArthur Foundation [and Management Sciences for Health], we have been able to connect across states and provinces to diffuse our resources and our influence.

What are some obstacles you currently face?

I really enjoy the work I do with midwifery students who come to work alongside us. I want to help them learn and enable them to provide better care to their patients, and so far I believe I have succeeded in doing so. However, there are difficulties in overcoming barriers among doctors in order for them to see midwives as those on equal ground. There is a significant level of resistance, so we must often restrain ourselves to simply be a supplement for pregnant women rather than the main point of care.

What do you think about the situation of midwives in Mexico, in general? What needs to change?

Unfortunately, we know there are midwives, that we would call more traditional midwives, which do not receive the resources they need. They were actually were banned from certain hospitals and healthcare centers due to their lack of a specific qualification, whether they actually could provide the services or not. What we have done in Morelos is to advocate for midwives to be able to carry out local courses that then enable them to provide the right care, with the backing of the authorities. Doctors are currently the greatest obstacle as their attitude prevents significant progress. My intention right now is to implement our midwifery model and then work with traditional midwives so that local government can help them get closer to the women that need their care, rather than be excluded from these environments.

What are some of the gaps you see in reaching women and girls with quality maternal health services?

Promoting sexual health and education is one. Women don’t have such a great problem, as the primary health care level does a pretty good job of assessing their needs, orienting them in terms of family planning and taking adequate care of their babies. However, the story is different with children. Just last week, a fourteen-year-old girl came to our hospital, pregnant. These teenagers don’t know what giving birth is, or how the process of pregnancy will unfold.

Much higher levels of education are needed, and parents are a main impediment to this, as they believe their children don’t need this knowledge yet. In schools, there are high numbers of children which don’t receive the correct sexual education as parents don’t want them to receive it and so schools don’t include enough education and support resources into their curriculum. Due to their ignorance, they end up pregnant, without knowing what to do.

Overcoming this taboo is extremely important so that teenagers understand their sexuality and parents understand this process. The best way to do this will be to encourage the government to provide grants and scholarships which entail a mandatory medical check where health professionals can direct these children and teenagers on sexual education and issues. This is a great opportunity for midwives and doctors to reach women, girls, and children.