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Mexico – the living, dynamic – and now menaced - wisdom of traditional midwives

Interview with Claire Laurant, a doctor of anthropology

Claire Laurant-Berthoud has been in close contact with traditional Mexican midwives for more than 25 years. The precision and wealth of their knowledge, developed from multicultural traditions and life experience, has never ceased to astonish her.

What were your first contacts with these Mexican midwives, and how did you approach them?

Claire Laurant-Berthoud : My first encounters with these midwives of Indian origin took place in July 1983 in the marketplace in Sonora, central Mexico. The meetings were part of my studies in anthropology. The first woman with whom I spoke was a midwife of the Nahua (Aztec) people, a very charismatic personality. She had arrived from the mountains carrying bundles of plants, and many people came to ask her advice on their health problems. Subsequently, I met more and more midwives and interviewed them, I went to gather plants with them, I took part in their consultations – in this way I gathered a mass of data and anecdotes about their knowlege and their life-style. Over a period of 20 years, I followed five teachers on a regular basis, and met with another twenty from time to time. This group was very important for the development of a sum of their general practices, with their very varied cultural origins - Indians, women of mixed races, descendants of the colonists, urban and rural women,as well as migrants from other regions of Mexico…

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Plants for the marketplace of Sonora, Mexico

Where do they get their knowledge from? How do they make their apprenticeship?

Most of these midwives have in their family circle a traditional therapist who has passed on their knowledge. They are perhaps the grand-daughters, daughters or nieces of other therapists. Incidentally, they are not only midwives – they are also herborists, bonesetters, healers… Each one has her own therapeutic speciality. Their knowledge has been developed over the centuries, but it is dynamic, always in the process of elaboration. These midwives are the inheritors of wise medicine, like that of the Aztecs, who had a very advanced understanding of the therapeutic affects of plants. They have also inherited the popular Hippocratic medical practices which were introduced in the Spanish Conquest. Their practice is a mixture of two heritages, it is constructive and dynamic. They adapt themselves to the curtrent context – for example, they have developed anti-AIDS medicines, and know how to cure problems of infertility, which is very common in Mexico. They have extraordinary experience of real-life work in a context where therapeutic ressources are minimal. Some of them assisted their first birth at the age of nine! They learn as much from tradition as they do from experience.

Do they share their understanding and practical experience with each other and with other therapists?

Since the ratification of the WHO treaty concerning traditional knowledge, they are obliged to receive training in their local health centres. This structure has deepened their knowledge of questions of hygeine and brought them into contact with other visions of the world. They have often worked as assistants for local doctors. They are pragmatic, and quite capable of integrating these various techniques in order to deal with health problems. For example, in cases of placenta praevia (where the placenta is expelled before the baby) which have not been identified by echography, they encourage the mother to crawl backwards on all fours, movements which cause the placenta to re-integrate – the baby can then be born normally, without surgery! They use massage to alleviate pain or other difficulties for the pregnant woman. Massage also prepares the baby for birth by moving it into the most favourable position. They see these pregnant mothers once a month, and this regular checkup helps to avoid many C-sections and episiotomies. They do not hesitate to send women whose pregnancies may be problematic to the health centres.

They are often confronted with very difficult social situations concerning surrogate mothers, who are numerous in Mexico, or with abandoned children. In this sense, they play an essential part in social regulation, by managing these problems in their own community. In many families, the husband goes off to work in the United States, and the wife is sometimes left pregnant in the absence of her husband… The midwives try to manage these complex social situations with humanity and intelligence. They are important personalities in their communities, and each of them is known and appreciated, even beyond their own community, for her speciality, for example, treating problems of fertility.

So they have a global approach to their work, both therapeutic and social. What about the spiritual or ritual aspect?

Their approach is indeed global, they treat both body and soul. They all know how to « clean » the electro-magnetic body, purifying it with a sweeping motion above the body with a bouquet of aromatic plants. They know the plants that absorb the negativity of a location. Their beliefs are very varied, drawn from both the pre-Columbian era and a form of re-adapted Catholicism.

What place do they occupy in the context of the Mexican medical system?

Currently, the function of these midwives in Mexican society is endangered by the public health policies which take away many of their responsibilities. Their dimension as therapists is denied, and so is their knowledge of the pharmacopaiea – they have been transformed into no more than « assistants » for pregnant women (on the model of the American doula, or labour coach), or even simple distributors of medication. Childbirth must now take place in hospitals - in the space of three years, the average number of births that they supervise has dropped from thirty to no more than three. Efforts are being made to restrict their knowledge to appear as little more than a reductive facet of Mexican folklore. They possess an understanding and power, and everything possible is being done to dispossess them of this and give it to others... And yet they are necessary to the well-being of the population, even though their practices should of course be supervised.

Can you give us an example which illustrates the precision of their knowledge?

A very good example is their use of the shrub Montanoa tomentosa, a plant of the Asteracaea family (the same as the dandelion and the artichoke), which grows only on the altiplano of central Mexico, at between 1400 and 2500 metres. I wrote a monograph on this plant. The midwives told me how they use this plant between the first and third month of pregnancy in order to provoke an abortion – and also between the seventh and eighth month in order to prevent premature birth, in cases of contractions. And at the moment of birth, at 7/8 dilatation, they suggest the use of the plant to accelerate the birth process. They specify very precise doses for this latter use – two leaves in infusion in a cup of hot water or hot chocolate. A priori, the indications seem to be contradictory. But when the plant was analysed in the laboratory, it was noticed that the effects are inverted according to the level of progesterone present in the plasma… the midwives knew this by experience. Certain laboratories extracted the active principles of Montanoa tomentosa in an attempt to produce a cheap, plant-based contraceptive, but it was quickly revealed as being both toxic and inefficient.

In the 1930’s, doctors did not yet have chemical medication, and appropriated this plant from the altiplano as a substitute for ergot of rye, and forbade its use by traditional midwives. Laboratories have continued to work on a contraceptive based on the plant, but have never managed to make a commercialisable product which is both non-toxic and therapeutically useful.

Currently, the plant is only used in the galenic form specified by midwives for the last 200 years – this is both efficient and non-toxic. In Nahuatl, the Montanoa tomentosa plant is known as « sihuapatli », which literally means « woman remedy »... We remain astonished by the precision of such empirical knowledge, supposedly acquired by trial and error…

Unfortunately, this remarkable knowledge is in the process of being lost. Few people are interested, other than from the profit perspective, which exerts strong pressure on the environment – as for the midwives, they harvest the plants only as they need them for therapeutic uses, and never in massive quantities with a view to profit. Their relationship with nature is founded on reciprocity and respect.

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Montanoa tomentosa in codex badiano

Claire Laurant-Berthoud is a member of various associations of researchers – the Société Suisse des Américanistes, the Société Française d’Ethnopharmacologie, the Réseau AMADES d’anthropologie médicale - applied to development projects in the health sector.

She has assumed several missions to Mexico, particularly recently in 2008 and 2009, concerning the role of traditional midwives in questions of reproductive health for the Scientific Cooperation Project ECOS/North/Mexico.

She works with Sevene Pharma laboratories as director of Research and Development, scientific documentation, technological and legal advisor, coordination and composition of the clinical and toxicological documentation for Marketing Authorization dossiers for the Agence française du Médicament.

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