Around two years ago I initiated the passage from obstetrics to midwifery. I have never been a physician, but our university midwifery program is technocracy-based, and we are educated under strong obstetric-gynecology philosophy. During that transition, an aspiring midwife from the US told me that in Argentina—my country—there are still traditional midwives. As part of my “recovery,” I was very interested in these true parteras. I could imagine myself in the middle of the jungle or walking down narrow paths collecting herbs, praying in a hut, using touch to share birth energy and mystery.
Traditional midwives are living dinosaurs; they are disappearing, they are hidden, they are threatened in different ways—legally, abandoned in their practice, dismissed. In Argentina only traditional midwives practice external cephalic version (ECV), attend breech babies, heal using natural, safe and useful remedies. For these women birth is part of life, it is a natural event. It is not like a movie, where somebody disabled must be rescued. Their retellings don’t sound like heroic deeds, just different ways of being born—though not all of them easy.
I heard that traditional midwives could be found in rural areas. So, when I had the opportunity to work in a northern province, I started my search. Thanks to God’s blessing, they sent me to work in a community far away in the mountains for a few days. As before, I began asking about the existence of traditional midwives. By late evening of the first day I was there, I saw a woman sitting in an arm chair. I felt inside that she was a midwife. She knew I had been asking about her because a neighbour had spread the news. She had old granny hands, a beautiful smile with plentiful white teeth and such warm hugs. She was exactly what I had imagined! Doña Aurelia Ayala told me she had ridden her mule seven kilometers to meet me. God’s gifts are overwhelming. She invited me to spend the night with her.
After finishing my duties, I was taken to her house in a Mercedes Benz 4 x 4. The road was in bad condition because of the horse tracks. It was nearly fall, and the evening was growing dark.
Down the hill, with a light in her hands, escorted by two of her grandsons, there she was.
She invited me into one of the little houses made of mud and straw. And as we do in Argentina, we started drinking mate and getting to know each other.
Doña Aurelia Ayala is 69 years old. She doesn’t know how to write or read. At the age of 19, she assisted her first birth—the birth of her twin brothers! She really enjoyed it. Her mother attended some births, too, because in the community of Anfama there was no clinic, and women assisted one another.
Doña Aurelia gave birth to 12 sons of her own, helped by her mother, neighbour, husband or daughter. One of her two daughters gave birth in a hospital in Buenos Aires and died; the baby lived.
People seek Aurelia when the time comes. She uses her santitos (Holy Cross) and yuyitos (herbs), among other things. Her husband, Jesús Aybar, used to come along at night. He kept a record of the births Aurelia assisted. She never wanted to be paid. A man—the community nurse—started doing her job and collecting money, which bothered Jesús. When things went wrong the nurse sent the women to Aurelia.
Aurelia assists women both in her home and in the women’s homes. If the labor is long, she stays with the woman. She says manzanilla (common chamomile) or malva (mallow) and food oil enema provide pain relief. To induce labor she beats eggs and sugar and adds lemon juice. Aurelia says this gives the weak woman “labor desire.” She gives three cups of herbal tea with Santa María (Holy Mary), called Jardín de Dios (God’s garden), as well.
Aurelia says: “To manage things you must be patient. Danger is in fear. For things to go on well, you must be patient, not nervous.” If she attends a woman who is “out of control,” Aurelia tries to calm her. She checks the fetal heart rate with her ear and says you can auscultate posterior babies in the mother’s back. She tells women in labor to walk; “bed tires and causes hip pain.” She believes labor is shorter and less painful when the baby is a male.
Sometimes when the baby is born covered with the membranes, people say it is a blessing, good luck, that it is covered by the manto (mantle). After the baby is born, Aurelia waits till the cord stops resuyar (pulsating) and cuts it. She prefers it long. She uses linen soaked in alcohol for this. Then she ties the placenta cord to “the long bone of the leg.” (Imagine the placenta is still inside the mother’s uterus, the placenta cord comes out from the perineum. So, she ties the cord with a linen and connects the cord to the mother’s leg—to the bone up the foot.)
Aurelia takes care of the baby at first, so the mother can birth the placenta. She bathes the baby, especially if she sees green fluids (meconium or trichomoniasis). She puts food oil on the baby’s body and anoints the pupito (base of umbilical cord). She recommends this so the umbilical cord will dry and fall off quickly. “Clean the umbilical cord with alcohol only once—when the baby is newly born,” Aurelia suggests.
For hemorrhages she uses these oyuys: oreja de palo (stick ear), a red herb; oreja de ratón (mouse ear) or piedra blanca (white stone), plus laurel and corcho (cork).
Aurelia stays the first night after the birth, but if the mother is feeling well, she leaves and returns the next two days or sends messages.
Aurelia has assisted two breech babies. She practices ECV successfully. She encourages women to walk. If the water bag breaks, she waits. Making a vaginal exam, she looks for the feet, then touches them till they begin to appear. She slowly moves the feet (it doesn’t matter if the toes point up or down); first a slight side-to-side movement, then up and down. She waits for another contraction for the head to come out, which, Aurelia says, “comes out like a shot.”
Ten of her deliveries have been twins, all homebirths, of course.
Aurelia can rotate babies by doing vaginal examinations. She can feel whether the water has increased—polyhydramnios—by palpating the belly. She also mentioned “dry delivery”—when there is little liquid as a result of membrane rupture or oligohydramnios.
Aurelia’s equipment includes: her santitos, the yuyitos, Pinard stethoscope, gloves, alcohol, enema equipment, linen, scissors, soap and clean towels for the baby and to dry her hands. To sterilize the scissors, she first cleans them with soap, then alcohol, then boils them in water for un ratito (approximately ten minutes), then uses alcohol once more and finally dries them.
Thirty-one years have passed since Aurelia’s first birth. She was invited to work in Nuestra Señora de la Merced Maternity Hospital in San Miguel de Tucumán City. These days between 30 to 45 babies are born there every day. She worked and lived there for three months. She met a friendly doctor who taught her many things and gave her a metal box containing a pair of scissors and suturing instruments. She learned about suturing and using local anaesthetics and treating itchy thrush with bicarbonate of soda or boric acid baths.
Regarding maternity wards, Aurelia says: “They hurry the babies without respecting their time. This makes the babies die…. They cut (episiotomy) to hurry. They use IVs to hurry, and make women give birth before their time.”
She attends seven births per year; none of the babies have been stillborn or handicapped. She has never lost a mother, either. When I was there, her last homebirth had been the month before. All the women talked about Doña Aurelia with admiration and gratitude. One of them told me how Doña Aurelia had helped her when she was having a long labor and things weren’t progressing properly. They called the midwife. She succeeded in talking the baby out and made it breathe after the difficult birth. The same woman told me that once Doña Aurelia had been called to help a woman with a stillborn baby who couldn’t give birth for several days. Doña Aurelia finally saved the mother.
In Anfama community, a visiting doctor usually records the due date of the pregnant women. At 37 weeks, the doctor takes her down the mountain by horse on a journey of approximately six hours. This woman will stay in the hospital till labor begins. She may pass a whole month waiting far from her home, her life and her other children. Not all women want to be taken. Some of them decide not to go and are assisted by Doña Aurelia.
That night I slept in a little room made of mud and straw. Aurelia slept in a bed next to mine, so I would feel comfortable. She told me to have a nice sleep and blew out the candle. I had very peaceful dreams. The next morning, I woke up and I found a bucket of water. I washed my face and combed my hair. Dawn was in the air. Aurelia was waiting for me with a breakfast of mate and homemade bread and cheese.
Jesús Aybar works with leather. He makes saddles and other riding equipment. Aurelia feeds the geese, the pig, the dogs, the horses, the cows, the sheep and the goats. She loves weaving on a huge frame, where she can finish a double quilt within a week. She dyes the wool bright colors and makes designs. She says the mountain air is clean, which makes the people who live there strong.
Talking to Aurelia, I felt she knew many things, perhaps much more than or at least as much as the young women who have access to the Internet, books in other languages, drug management, conferences and triple the number of births. I could feel peace and spiritual midwifery in her; accepting herself as a God’s instrument, asking for his blessing in each birth. Another thing that amazed me is the universal nature of midwifery and births. Aurelia, in the middle of nowhere, with no access to outside information or learning sources, knew exactly what to do. And I could identify the same procedures that midwives from North America, Central America and in the hospitals perform.
Sometimes in my daily duties in the hospital wards, or talking to other colleagues about the art of midwifery, or in classes for parents, fear invades me. I am haunted by technocracy and obstetric-gynecology paranoia, and these make me less confident. At such times, I think of all these women, these wise women, where life is so simple. When I feel I’ve lost my way and want to remember where I have come from and who I am and I need to centre myself, I think about those anonymous, skilled ladies all over the world, all over human history.