Birth Choices in Venezuela
by Fernando Molina
© 2008 Midwifery Today, Inc. All rights reserved.
[Editor’s note: This article first appeared in Midwifery Today Issue 86, Summer 2008. It is available in Spanish here: Opciones de Parto en Venezuela]
Venezuela, a country of many beautiful traditions, nowadays lacks traditional midwifery and professional midwives. As a result, Venezuelan women have few alternatives regarding birth choices and usually end up birthing in the technocratic model. This means they have an 80% chance of a c-section when birthing in a private clinic or a 30% chance when birthing in a public hospital. Women who are “allowed” to give birth vaginally (but not naturally), for the most part have very bad experiences—far from what we know to be humanized birth for the mother, father and their child.
To balance this situation, we have a few “humanized” doctors in some cities across the country. They offer the kind of care every woman and baby deserves during pregnancy and birth, although we still have a long way to go in order to reach the critical mass needed to change the collective consciousness. Still, some of us are doing—to some extent—the joyful work of a midwife, or an approximation to it.
History of Midwifery in Venezuela
In Venezuela, in the 1940s and early ’50s, traditional midwives doing homebirths were still accepted, mostly because of a lack of hospitals and doctors. As the number of obstetricians increased, the Department of Health attempted to incorporate midwives into the health care system by giving them some instruction and placing them in hospitals with maternity care. The board of directors of the Obstetrical Society in those days absolutely rejected that approach.
Since then, the medical system has refused to work with traditional midwives and has mostly refused to provide back up for them in emergencies, blaming them for maternal mortality that often results from complications the midwives were not able or did not have the training to resolve. Most of these midwives worked under poor conditions of sanitation and did not have the necessary supplies or adequate backup. They felt very alienated and, consequently, for the last 60 years women and their daughters did not learn or experience the value of midwifery for the community. Most of the midwives abandoned their practices, and the few that survived got old and retired. Currently, you can hardly find a traditional midwife in the suburbs of some Venezuelan cities; only a few can be found in rural areas, mostly in the mountains of the Andes.
In February 2008 I did some field trips in eastern and southern Venezuela, looking for traditional midwives. I found a few who are retired or only help their relatives. They wouldn’t talk much and I could sense the fear some had about talking to a doctor. Through their eyes I could see the injustice they had suffered from the medical system in Venezuela; it buried their wisdom, their skills and their faith.
In the Orinoco Delta I met two indigenous midwives, in the Warao village. They were very reluctant and did not want to communicate. Many of the people from this area have moved to the urban cities to improve their living conditions, and their pregnant women end up at the hospitals to give birth. A few give birth in their huts, attended by their husbands.
I also know of the Yekuana tribes through some of my patients, American missionaries who worked in the jungle area of the Venezuelan Amazon, which is reachable only by plane. The tribespeople have their midwives and during the birthing process they do not allow any man to be around. So we can say that in most parts of Venezuela, only the indigenous tribes still have midwives working as such.
Public Sector Activity
The government of Venezuela, through the Ministerio Popular para la Salud (People’s Health Ministry), started a program two years ago called “Proyecto Madre” (Mother’s Project), which was designed to diminish maternal and neonatal mortality. Their main goal is to guarantee prenatal and postnatal care through community involvement, what they call “Consejos Comunales de Salud.” They do this by encouraging pregnant women in their communities to attend prenatal care, take their vitamins, breastfeed their babies and have the babies immunized. The program has worked in some states.
In the Bolivar state where I live, it has not worked efficiently because, according to the head of the program, the promoters don’t get paid. However, from my perspective, the Mother’s Project has a bigger problem: In most cases, women are sent to the public hospitals to give birth alone under the technocratic model.
During the last two years, in just three states (Aragua, Vargas and Margarita Island), humanized obstetricians and/or private institutions, doulas and some pediatricians have worked with local state government offices and mayors to build birth centers and incorporate doulas and gentle births, with the ultimate goal of humanizing births in public settings. So far, though, they have shown no intention whatsoever to bring back to life and include the profession of midwifery in the public health system.
Private Sector Activity
In Caracas, there are a few private clinics and several humanized centers headed by excellent obstetricians: Auroramadre, Aquamater, Buenacer, Embarazarte. All teach prenatal classes, and Buenacer is dedicated to training “facilitadoras de nacimiento” or doulas. In one clinic, two obstetricians work with one or two midwives from Chile. All of them offer vertical births and waterbirths.
A few other cities have compassionate obstetricians working alone towards the humanization of birth. For the most part, they work with a doula and a pediatrician. Most of them like to have all the technology at hand for the “just in case” situations. As far as I could determine, only two or three are involved in occasional homebirths. Most said they feel better in a birth center or a clinic.
My Local Situation
I live in Puerto Ordaz, a city of approximately one million people, in the southeast part of Venezuela. I have worked as a Family Physician in this city since 1984. Sometime in my career I found my dharma, which led me into searching for better and more humane ways to treat women in labor and their newborn babies. I’m sure that my grandmother Blanca has to do a lot with me working with love as a “midwife.” She was a dedicated and beloved matrona (midwife) in the city of Potosi, Bolivia.
I have had to erase a lot of information they taught me in medical school and re-learn the physiology of birth. I had to give away the controller doctor and look for the “Patch Adams” inside of me.
My first son, Fernando, Jr., was born at home 24 years ago—a vertical birth, with just mom dad and four-year-old sister present. What a joyful and blissful moment when I first touched his head emerging from that sacred place of creation.
For some years I helped with a few homebirths and finished my Family Practice residency. It was awkward during my obstetric and neonatal rotations: I had to give answers to exam questions about birth the technocratic way just to have a passing grade! Yet I already knew there was what I called “the midwifery way”!
Ten years ago I recognized that I needed further studies and went to California, where I got certified as a “Magical Beginnings Enchanted Lives” prenatal instructor at the Chopra Center for Wellbeing. There I learned to embrace the mind, body and spirit for a conscious pregnancy and childbirth. When teaching the course, which has been expanded and adapted, I do my best to guide every woman to rediscover her divine power to give birth naturally.
So far we have graduated 47 groups (average five couples per group) and have incorporated the husbands well in all of the pregnancy and birth process. Lately they are the ones who receive their babies at home. The experience is so inspirational that I have lived it twice in my life. My daughter Paola was born in water a year ago. My wife Haylen works with me as a doula from her heart. All the women love her wisdom, massages and support during labor.
I have been dedicated exclusively to homebirths during the last eight years. For the women who did not feel safe at home, I previously delivered babies in two private clinics, since the rest of the health care system prohibited me because I was not an obstetrician. Then eight years ago I was told in one of the clinics that I was giving them a bad reputation, since I attended births in the manner of the indigenous groups. In the other clinic, I was told that I had to deliver babies the “right way” and not like the “old parteras.”
“What is technology here for?” they asked.
I realized then that my calling was to give love to pregnant women and their babies, doing only homebirths, and to let them know I am present and will only act if absolutely necessary. The body of every woman knows how to give birth if we give them their sacred space, intimacy, trust and love.
So here I am, very happy to have found the midwife within me. We have turned our home into a cozy birthing center, where we offer the “Comienzos Magicos” course for preparation for motherhood and fatherhood. We have the honor to help with one or two births a month, mostly waterbirths. So far we have had one breech birth and four VBAC births.
Three years ago I had the honor of meeting Barbara Harper, who has given us all her love, knowledge and support. During the three-month prenatal course I learned that time is necessary to build empathy with the women who decide to have a gentle birth at home. I tell them that first they have to learn to trust themselves and then to trust me. We provide all the necessary information based on evidence, intuition, logic, love and surrender, and then give them back their autonomy, which women handed to doctors some decades ago.
Over the years it has been an interesting and nurturing struggle with the technocratic paradigm obstetricians, pediatricians and the collective consciousness in our city. But be assured that the critical mass of gentle births will increase over time, and we at Magical Beginnings in Puerto Ordaz, Venezuela, are working with mysticism, love and joy for our humble contribution to life.
Fernando Molina is family physician, certified prenatal instructor and midwife in his hometown of Puerto Ordaz, Venezuela, population approximately one million people. Fernando considers himself a midwife at heart, and his wife, Haylen, works with him as a doula.
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