Owner: National Library of Medicine
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Latin American medicine can be divided into two broad categories, biomedicine (modern western practices) and ethno-medicine (the more traditional healing practices of American Indians). This division extends to many of the specialized subfields of medicine, including obstetrics and midwifery, and even today the majority of women living in poor rural areas of Latin America visit midwives, or parteras, for prenatal care and the birth itself.
The Mexican state of Oaxaca, where about 80% of all births in 1990 were done by rural midwives, became a site of tension between bio- and ethno-medicine during much of the twentieth century, an era of self-conscious modernization for the Mexican state. The government censored ethno-medicine as primitive until the mid 1970s, when the medical establishment decided that a few aspects of Indian healing, namely herbal medicine and midwifery, could be actively modernized to improve rural healthcare. In the late 1970s and early 1980s, the government provided formal training to over 15,000 parteras. The training, however, belittled Indian obstetric knowledge, and instead of trying to find a constructive middle ground between the two medical traditions, the instructors tried to impose bio-medical practices and replace Indian ones. Despite taking these courses, the vast majority of midwives did not change their methods.
Part of the reason why most ethno-obstetricians have been reluctant to co-opt western practices is that they are experienced with conducting very different kinds of examinations than those taught by modern nurses. For one, ethno-obstetricians do not actually come into contact with the patient's vagina or internal sexual organs. Instead, they do the entire examination externally, by massaging the stomach and back of the pregnant woman (known as a sobado), moving the uterus to a more central position, and, if necessary, performing external versions (rotating the fetus to a head-down position). The bio-medical nurse-instructors, however, strongly discourage the sobado, claiming it can harm the fetus, but the vast majority of midwives continue to perform this procedure largely because it is what their patients want and expect.
The knowledge of Oaxacan midwives is very different from that of western obstetricians, yet it is nevertheless based on a strong empirical tradition that continues to engender the trust of local residents. Many recent commentators stress the need for fusing the most useful aspects of bio- and ethno-medicine in order to provide the best possible primary care to rural areas, yet a deep divide between these two empirically-developed traditions still persists in many areas.
Reference: Sesia, Paola M. "'Women Come Here on Their Own When They Need to': Prenatal Care, Authoritative Knowledge, and Maternal Health in Oaxaca." In Medical Anthropology Quarterly, New Series, vol. 10, no. 2 (Jun., 1996), pp. 121-140.
CITATION: "Auxiliary in public health nursing visits midwife in rural Mexico." United States National Library of Medicine, National Institutes of Health. Order #: A016731.
DIGITAL ID: 13109