CASA Midwifery Project

AMISTAD CANADA is working with the Centre for Adolescents of San Miguel de Allende (CASA) to enhance midwifery services and education in Mexico. This project helps to finance the salary of the Clinical Director in CASA’s School of Professional Midwifery.

Our involvement in the education of midwives can be traced back to the 1980s, when a small group of Canadians decided to support the work of the Centre for Adolescents of San Miguel de Allende. They were particularly interested in CASA’s Midwifery School, which was the first, and until recently, the only, school for professional midwives in Mexico. This group continued to support the School for more than two decades and eventually became involved in the founding of Amistad Canada. When Amistad launched its first project, in 2010, it built upon this history and made a commitment to pay the salary of a Clinical Coordinator for the School.

That position, now designated Clinical Director, is currently held by Marlen Mejia, herself a graduate of the CASA school.  Her main task has been to supervise and manage students during their clinical placements and oversee the work of what is now a small team of Clinical Coordinators whose duties include follow-up of graduates doing their required year of social service.  She is also involved in several other activities, including the collection and review of data on birth outcomes under midwifery care and the education of other health care professionals about midwifery.

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Background

Mexico has a long history of traditional midwives working mostly in rural areas, but has lacked training and recognition of midwifery as a profession. CASA’s commitment to midwifery began in 1985 with local midwives who requested help in learning more midwifery-related skills. Then, in 1994, the CASA Maternity Hospital opened, providing these midwives with a place where they could provide care, and in 1996 the first students were accepted into the state-approved educational program.

The School at CASA has as its goal the formation of professional midwives who can independently provide services to women in communities throughout the country, attending births in hospitals, birth centres and at home. CASA's midwives also are educated to provide gynecological care for women at all stages of life. The United Nations has recognized the importance of professional midwives as skilled birth attendants in countries such as Mexico, with a view to lowering unacceptably high levels of maternal and infant morbidity and mortality. Another concern is the overuse of medical interventions such as cesarean section – here too midwives are known for their more appropriate use of technology. This is reflected in a study comparing the usual care by physicians in Mexican rural clinics with the care provided by CASA-trained midwives and obstetrical nurses. In the midwife/obstetrical nurse group, it was found that women had more visits and more appropriate care was given at birth. (Walker, 2013)

"CASA is still one tiny birth model that works, in a vast region that needs many more, but it has opened a humanistic chink in the system, and its replication is ensure."

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Dilys Walker

Affiliate Associate Professor

“CASA's program is unique.  The curriculum is based on the principles that pregnancy and birth are normal physiological proceses and that the expectant mother is the primary decision-maker in regard to her care."

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Robbie Davis-Floyd PhD

Senior Research Fellow

CASA’s program is unique

CASA’s students do a three-year program at the technical level in which they gain experience in a variety of settings. They also work with traditional midwives in their communities. Care extends into the period after birth and includes family planning.

CASA’s impact throughout Mexico and beyond

The CASA School has 110 graduates. The emergence of several new midwifery schools in the country, based on the CASA model, is offering graduates the opportunity to become leaders in the profession, working as educators and administrators and staffing midwifery units. While the program at CASA is small, the school has had a major impact on the growth of professional midwifery in Mexico. In 2010 the federal government added midwifery to its list of health care professionals, opening the possibility of government funding for midwives.

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Six new midwifery schools are now open or scheduled to open, operated by a mix of state governments, universities and non-profits: Guerrero graduated its first class of 18 students in 2016, and 25 are expected to graduate in 2017.  Midwives are staffing a birth centre in Chiapas.  There are schools functioning in Chiapas, Oaxaca, Morelos and another is about to open in San Luis Potosi. The CASA model has extended beyond Mexico's border to Guatemala where one school has already graduated its first group of students.  All of these schools are closely linked to CASA, in that they receive direct support in developing their programs and, like the CASA school, they are committed to being accessible to low-income and indigenous students. CASA has also been actively involved in bringing about legislative and policy changes throughout Mexico. As well, CASA is developing on-line courses of obstetrical caregivers.

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More Information

Please check out the links below for more information about work done at CASA.