In New Mexico, midwives have played a vital role in maternal health for centuries, rooted in Native American and Hispanic traditions. Traditional Hispanic midwives, known as curanderas-parteras, were the primary maternity providers, with over 800 midwives statewide in the early 20th century. However, the US medical establishment has resisted certified nurse midwives (trained professionals) and their integration into childbirth care, reflecting a power struggle as doctors seek to protect their domain. Despite the documented benefits of midwives globally, they only participate in about 10 percent of births in the US due to restrictive regulations.
New Mexico stands out with a higher acceptance of midwifery, with midwives involved in about one in four births in the state, compared to the national rate. However, midwives and doulas, who offer emotional and physical support during childbirth, still face challenges. Some hospitals do not allow doulas in their labor and delivery units, and doulas are not eligible for Medicaid reimbursement. To address these issues, the Biden administration has increased investment in midwives and doulas, recognizing their potential to improve maternal health and reduce maternal mortality rates in the US.
Certified nurse-midwife Jeanne Stagner, who founded Organ Mountains Family and Women’s Health, has witnessed the worsening maternal health crisis during her 40-year career. She decided to establish her own health center due to the increasing patient loads in hospitals, which she deemed unsafe. However, low reimbursement rates and high malpractice insurance costs have put her business at risk. Licensed midwife Nandi Hill, on the other hand, faces challenges in providing comprehensive care due to limited reimbursement for her time and the traditional six-week postpartum care covered by Medicaid.
Melissa Lopez, executive director of the New Mexico Doula Association, emphasizes the importance of doulas in supporting mental health and overall well-being during pregnancy and the postpartum period. She aims to build a network of provider doulas of color to assist low-income and women of color patients. Jessica Lujan, a doula, herbalist, and reproductive justice advocate, notes that there has been a positive cultural shift in recognizing the value of doulas. Doulas provide emotional support, guidance, and access to mental health services, aiming to minimize trauma and create positive birthing experiences.
Overall, midwives and doulas in New Mexico face various challenges, including limited integration into the healthcare system, restrictive regulations, low reimbursement rates, and a lack of access to mental health services. Nevertheless, their role in improving maternal health outcomes cannot be overlooked, and efforts are being made to amplify their impact and address the current crisis.
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In New Mexico, midwives have been a part of the maternal health landscape since before statehood, rooted in Native American and Hispanic traditions and the work of healer-midwives — Traditional Hispanic midwives. For centuries, these healers and midwives were the main maternity providers. More than 800 midwives practiced statewide in the early 20th century.
In more modern times, however, the US medical establishment has strongly resisted certified nurse midwives (trained, licensed professionals who know how to deliver safely) arguing that they should not be allowed to take the initiative in childbirth care. The failure to integrate them into the health care system reflects an ongoing power struggle: Doctors seeking to protect their turf tend to mistrust and misunderstand them, advocates and providers say.
Meanwhile, the benefits of midwives are documented around the world. Midwife-led maternity care reduces the rate of neonatal deaths, stillbirths, preterm births, cesarean sections, and low birth weight among babies, studies conclude. It can also significantly reduce maternal mortality.
However, midwives participate in only a few 10 percent of births in the US. In some states, they face complex restrictions and regulations that block their ability to practice or obtain a license.
New Mexico accepts midwifery more than most. The midwives here are involved in about one in four births, more than double the national rate, according to the Department of Health. But they are chronically underpaid.
Similar problems hamper the state’s doulas: non-medical professionals who offer guidance, emotional support, and physical support, before, during, and after childbirth. Some hospitals do not allow doulas inside their labor and delivery units, advocates say. And doulas, to date, are not eligible for Medicaid reimbursement.
To address some of these issues, the Biden administration last year order increased investment in midwives and doulas, along with many other actions to combat the US maternal mortality rate, the highest of any high-income nation in the world.
In New Mexico, increased use of midwives could significantly improve the maternal health crisis and reduce the high rate of maternal deaths, advocates say. In a state where 1 in 3 counties is considered a maternal health desert, and 1 in 3 women gone without early antenatal care – midwives are seen as crucial in closing the gaps.
However, change is slow in coming and some midwives and doulas say their very existence is at risk. Searchlight New Mexico set out to hear them firsthand. (The following interviews have been edited for length and clarity.)
During her 40-year career, certified nurse-midwife Jeanne Stagner has had a front-row view of the deepening crisis in maternal health care. Originally trained in El Paso by an indigenous midwife, she had previously lived in Las Cruces and moved nearly seven years ago to serve the bicultural community.
Year after year, Stagner says, hospitals kept increasing patient loads, to the point where he felt the numbers weren’t safe. “Expect to see 25 to 30 in a day. you can not [do it] without risk of poor outcomes,” says Stagner, who is also a family nurse practitioner.
So, in 2020, he founded Organ Mountains Family and Women’s Healthjoining the ranks of the approximately 270 midwives in the state currently providing services in hospitals, birthing centers and homes, according to the Department of Health.
His own house serves as a health center. Her daughter’s former bedroom has been turned into a delivery room, where doulas and loved ones are welcome. A former study was converted into a mommy and baby exam room.
Eighty-five percent of his clients have Medicaid, Stagner says. But the state’s low reimbursement rates and the high cost of malpractice insurance have put her at a crossroads. Providing labor and delivery services is so expensive that “I run the risk of going out of business.” Factoring in all the expenses, he says he basically works for free for two months out of the year.
But Stagner knows what it’s like to suffer with poor medical care; she has made her determined to serve the community. “I was driven by my lack of good treatment to be part of the solution,” she says, sitting in what used to be her family’s living room. “I felt like I had no other choice.”
Nandi Hill moved to New Mexico from Chicago more than two decades ago to work as a Certified and Licensed Professional Midwife (CPM), who until 2022 it was illegal in Illinois.
She founded the Wadada midwifery care in Albuquerque in 2012 and is one of the few black CPMs in New Mexico, someone who works especially with black families, she says. She also cares for people in rural areas, including indigenous patients from Gallup, a Navajo Nation border town that lost a labor and delivery unit at a local hospital last year.
Some Gallup families travel 140 miles to Hill’s office in the Nob Hill neighborhood. “We do more than just take care of the pregnant woman and the baby,” she says. “We also give advice to grandmother, grandfather. How are they? How are they healing? Do you need some herbs? Do you need some medicines?
Low salary is a challenge. On average, prenatal care appointments at hospitals last about 15 minutes, Hill says. Midwives, by comparison, spend an average of 45 minutes or more per appointment. But they are not reimbursed for all the time invested. Another problem: Medicaid traditionally pays for postpartum care at six weeks, but midwives like Hill do multiple checkups before then.
After delivery, “I’m back home in 24 to 36 hours,” she says. “I’m back at your house in three days. I will return to your home in seven days and any time in between. I’m back at your house between 10 and 15 days. I go home at four weeks and I go home at six weeks.”
She had to get a second job in a midwifery program at a technical college in Wisconsin to support herself, she says. “I still do it because I’m passionate about it, but it’s hard.”
In New Mexico and nationwidea large number of deaths occur during pregnancy and the postpartum period due to lack of access to mental health services, suicide, or a substance use disorder.
After a birth, “Who is taking care of the mom? Who is checking her mental health, who is she talking to? says Melissa Lopez, executive director of the New Mexico Doula Association.
Lopez, who is Latina, says the NMDA set out to build a network of provider doulas of color, especially to support low-income patients and women of color who are trying to navigate pregnancy, breastfeeding, miscarriage or abortion. She has also been training with Stagner to become a midwife and hopes to open a new birthing center in Dona Ana County.
“We used to live in villages, we used to live in community. Our comadres, our sisters, they all came to help each other,” she says. “In today’s world, the way we live and after COVID, there is no village. We lost access to so much.”
Doulas can offer the emotional support that people are missing, she says. “We’ll keep an eye on the kids so you can shower or nap or go to the gym because you’re going to go crazy.” Along with other powerful advice, they also offer guidance on mental health services. The goal, says López, is to have the least amount of trauma and the most positive experience possible.
There has been a positive cultural shift when it comes to doulas, says Jessica Lujan, who spent more than a decade as manager of the Indígena Women’s Health and Reproductive Justice Program in United Tewa Women. “Groups of doulas,” she says, “are working together and tackling bigger problems.” Today, Luján is an advocate for reproductive justice and the founder of Hummingbird Heart, a community herbal center north of Española. She and other doulas also conduct training and meet with midwives and doctors in Española and Taos to build trust.
Doulas, he says, make sure that families receive holistic care and “that they themselves, as doulas, provide that holistic care for each other.”
Meria Loeks gave birth to all three of her children at home, something she wanted other women to be able to experience. In 2019 she inaugurated the Santa Fe Maternity Center to offer home birth services, prenatal and postnatal care. Less than 2 percent of births in New Mexico are home births each year, Show Stats.
“It’s a joy to be pregnant, not a disease state,” says Stephanie Williams. The more doctors are exposed to what skilled midwives bring to the table, the fewer false assumptions and misunderstandings they will have, she adds. She has done a lot of “repair work” over the years, separating myth from reality for pediatricians and OB/GYNs, “explaining to them what we’re really trained in and what we do.”
Countries like New Zealand, Norway and the Netherlands have some of the highest rates of midwifery in the world, and the the lowest maternal and infant mortality rates. In the United States, it’s a different story. “We are still a minority that needs to be protected,” says Sunday Law. “If the best results come from this type of care, let’s increase [it]legalize midwifery and educate more midwives.”
Mari González has had three high-risk pregnancies in the last two decades; one of her daughters was born prematurely at 29 weeks. For years, she couldn’t understand why the problems kept happening, she says.
Every time I went for prenatal appointments, the provider was different. The process felt rushed and she always left feeling confused. “You spent more time waiting for the appointment than with the doctor,” she says in Spanish. She decided to find a provider who could tailor care to her needs.
During her third pregnancy, in 2021, she finally connected the dots: she found Stagner, who discovered through blood tests that González had untreated anemia and gestational diabetes, high-risk conditions for pregnancy. With Stagner’s guidance, she and her entire family learned to eat healthier foods.
In May she gave birth to her fourth child, who was born healthy. She says that working with Stagner has done wonders. Midwives provide crucial information and give you “control over your body,” she says. “Emotionally you are calmer because you know that she is someone who knows you.”
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