Our thanks to Debbie A. Díaz-Ortiz, midwife from Puerto Rico for this blog:

The history of Traditional Midwifery is quite fascinating. Traditional Midwives practice midwifery as it has been handed down to them from generation to generation. Some of them have no formal training. I am a traditional midwife and I love my work. I learn to connect with pregnant women. We connect during stressful times. We connect through the gift of trust.

Traditional midwives were keen observers of physiological signs & symptoms and monitored fetal health by addressing the mother’s intuitive process, and, more recently, by using wooden acoustic listening devices today called Pinard horns, still used by many midwives, and later, fetoscopes, as did all early physicians.

Traditional midwives relied on maternal signs and symptoms and dialogue much more than constant vaginal exams, doing very few, when necessary, did not practice surgeries such as episiotomies, nor did they administration intravenous fluids and drugs. Such practices would have been considered the domain of doctors rather than the art of midwifery. The women of Africa continued the use of traditional midwives as primary practitioners in the arena of women’s health care.

The rights of traditional midwives are grossly violated around the world. Several midwives around the world debate on this topic. I find this to be a derogayory term. The article by Debbie Diaz-Ortiz will help us understand the basic issues facing traditional midwives.

The use of the phrase “skilled birth attendance” or the acronym TBA traditional birth attendant concerns and disturbs me and others I have communicated with in this region of our world and in other informal conversations. Instead, it is more accurate with our history and gentle to our emotions to create a definition for the term traditional midwife for the women who learn with colleagues and/or through experience.

Considering only those who have formal studies to be midwives is to deny the beauty and uniqueness of our history that I and many I have communicated with or read about are so proud of. Studying history in its depth (my B.A.) we repeatedly see life and learn that in situations where change is attempted by force, converted, [or denied], it just doesn’t happen. On the contrary, whatever is to change stays stronger or because of a noticeable sacrifice naturally, genetically remains in life and/or in our memories. As we have persisted through centuries, our name lives on.

When will all midwives have formal studies? Mostly when poverty ends [in the] continents of the world. When will poverty end? Maybe god has a date. When will midwives in this region of the world be called by other names between their neighbors? Never. Can we just define the term traditional midwife instead of use TBA for them? Most of them will never know about it, but in respect of their hard work, knowledge and the noble service they offer to women others are so afraid to give service to, we honor them. It’s all about our name and definitions. It’s a matter that should not pass unnoticed. And, the change should be a democratic decision of many, not of one—a real leader will never ask people to accept their opinion as the last word.

Do the strategies to formalize midwifery work in this region of the world? Really, no, it is an unnecessary battle. It has been so stressful for many who follow midwifery closely, who have seen it for years in other continents. It has caused injury so deep, the wound is so open. Let’s be midwives to our feelings; naturally this will protect, make an international recognition, open a door, go deeper in the importance of our linage, to justly integrate the elegance of our history. Projecting midwifery to the world proudly, in its essence, and, as it is, just exquisitely formidable in its wholeness. A name carries honuor and history.

Debbie A. Díaz-Ortiz, midwife Latin-American & Caribbean Network for the Humanization of Childbirth Puerto Rico, Caribbean