PHOENIX, Arizona -- Marinah Valenzuela Farrell is one of only a few licensed midwives in Arizona. Though it isn’t a profitable venture, helping mothers bring their newborn children into this world is for Farrell a calling deeply rooted in her native Mexican tradition.
“It is really hard to be a midwife,” said the 41-year-old. “You don’t sleep, and you don’t make money. People think you’re crazy because you’re doing homebirths.”
A majority of Farrell’s clients are middle class and white, though as a Latina she aims to make midwifery accessible to low-income women in dire need of prenatal services but too afraid to seek them out in a state virulently hostile to undocumented immigrants.
“I think they don’t know that we exist,” she said. “I think the more the community knows that there’s a midwife who will come and visit them at home and do a homebirth… [attitudes] will change and shift.”
Farrell is not alone. There is, in fact, a growing movement of women around reproductive rights that seeks to expand midwifery to make it more accessible for women of color. For many, midwifery is not just about homebirths, but also about ensuring a healthy pregnancy that allows the woman to make her own choices.
“It would be so helpful to have midwives in our community; they’ll solve a lot of the issues [surrounding] poor birth outcomes,” said Martha Garcia, executive director of Healthy Mothers, Healthy Babies.
Garcia founded the program almost 10 years ago in Maryvale, a mostly Latino neighborhood with little access to prenatal care.
A quarter of all Latina women who gave birth in Arizona in 2009 went without prenatal care during their first trimester, according to the latest data from the Arizona Department of Health Services. Three percent of them, the highest percentage of any other ethnic group in the state, sought no prenatal care at all.
“Improving prenatal care for the undocumented is a big issue here,” said Garcia, who also sits on the board of Maryvale Hospital.
“Women are just dropping in at the emergency room when they’re ready to have the baby with no prenatal care,” she noted.
Healthy Mothers, Healthy Babies employs what in Spanish are called “promotoras,” women who literally promote information about healthcare. They go door to door, teaching pregnant women about nutrition, and letting them know where they can get prenatal care.
Garcia explained that many of Maryvale’s immigrant women need to have the care delivered to their home, because so many of them can’t drive or live too far from clinics.
Undocumented immigrant women don’t qualify for AHCCCS, which stands for Arizona Health Care Cost Containment System, the state’s insurance healthcare program that would normally cover their prenatal care. As a result, most receive care through community clinics that offer sliding fee scales.
“The majority of the calls I get are (from women asking): Where do I go to see a doctor? Or, where do I go when I don’t have money?” said Garcia.
She added that with passage of Arizona’s SB 1070, which made it a state crime to be an undocumented immigrant, the situation for these women worsened. While SB 1070 was partially enjoined by a federal court, other more obscure laws like HB 2008 -- which requires state workers to report any undocumented immigrant who applies for social services -- continue unabated.
“It got worse because they were afraid of getting pre-natal care anywhere (even services they qualified for),” Garica pointed out.
Fear of going to the doctor, lack of insurance due to immigration status and a deeply-rooted trust in more traditional forms of prenatal care have led to a huge demand for “sobadoras” (women who practice traditional massage therapy) and “curanderas” (traditional healers) like Julieta Delgado.
Delgado is essentially a spiritual healer, trained to provide the kind of services offered by what are commonly known as a “parteras,” or midwives, in the southwestern Mexican state of Oaxaca. Before coming to the U.S. 10 years ago, she often assisted in births using techniques she learned mostly from her grandmother.
“Many women trust the midwife more than the doctor,” she said. “They come to see me, and I massage their belly and help to turn the baby (to help with a better position for the birth),” she said in Spanish.
In many cases, Delgado works with her clients through the entire pregnancy, though she said most women still prefer to go to the hospital during delivery.
She recalled one woman who called from the hospital when complications arose.
“I came in and said I was her mother. I told her to push, grabbed her legs and pulled the baby. The doctor told me, ‘You can’t do that,’ and I told her, ‘You bet I can.’”
Other memories have a less rosy ending.
One woman who was experiencing severe abdominal pain after suffering a miscarriage was told by hospital staff that it was a common side effect. Delgado says she realized that the baby was still in the womb, quickly preparing an herbal infusion and soon delivered the dead fetus.
“That was abuse,” she said. “But the woman didn’t report it.”
Delgado’s care is also affordable, which helps attract new clients.
“I charge them $20 to $30 when they come,” she said. “They go to the doctor, he doesn’t even touch their belly and charges them God knows how much.”
Bringing Midwifery to Women of Color
“Midwifery is an art,” said Farrell, who runs her own practice, called “Freedom and the Seeds.” Much of her own expertise is drawn from her time working in birth centers in Mexico, where she observed traditional practices by unlicensed parteras.
One such practice found among traditional Mayan midwives involves massaging to help with the position of the baby, explained Farrell.
“I value them,” she said, speaking of these women. “We love our traditions, [and] midwifery is based on traditional medicine and the traditional parteras.”
According to the Department of Health Services there are about 50 certified professional midwives (CPMs) in Arizona, and only a few of them speak Spanish. Nationwide there are about 1,100, according to the Midwives Alliance of North-America (MANA).
That certification means they are allowed to assist in homebirths. Others midwives that are trained nurses, known as CNMs, work in hospitals and birthing clinics.
But in Arizona, no institution offers training in how to become a CPM. Farrell trained in 2002 at Maternidad La Luz, a clinic near the U.S.-Mexican border in El Paso, Texas that services mostly immigrant women.
The clinic’s midwifery school was featured recently in the film "Catching Babies," which highlights the role of midwives in assisting immigrant women.
“The idea of the midwife is passive, is to assist the birth. It’s to catch the baby,” said filmmaker Barni Qaasim, who also pointed to the relationship of trust that develops between the midwife and the mother.
It is that model of “patient-centered” care that immigrant women need, said Miriam Zoila Perez, a blogger and creator of the site Radical Doula, which advocates reproductive justice and midwifery.
But challenges like improving language access and getting Medicaid reimbursements continue to stand as barriers to expanding access to prenatal midwifery care, she explained.
Zoila Perez, who has been a Doula for many years, argues that midwives provide a form of affordable care for uninsured patients and are a better choice for those women pressured into having costly or unnecessary c-sections.
In 2007, nearly one-third of all births were cesarean deliveries, according to a report from the Center for Disease Control. About 30 percent of all live births to Latina women were through c-section.
The procedure is nearly double that of a traditional vaginal birth.
Women of color are also more likely to die in pregnancy or childbirth than white women, according to the 2010 Amnesty International study Deadly Deliveries, which put the United States behind 49 other countries in terms of safety for pregnant mothers.
“Midwifery,” said Jessica Gonzalez-Rojas, executive director for the National Latina Institute for Reproductive Health, “is a really fantastic approach in reaching women that maybe marginalized by the healthcare system.”
A study put out by the Centers for Disease Control and Prevention in May showed there has been an increase in the number of women choosing to have a homebirth with a midwife. Latinas came in third after whites and blacks, with 1 in 500 women choosing a homebirth.
Still, Farrell and others say more needs to be done to counter prevailing notions about home births.
“Even those who grew up with the tradition, who had aunts that were or are parteras,” she said, “are conditioned to think giving birth in a hospital is better.”
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