Safe birth in cultural safety

Pilot RCT in Mexico

Mainstream policies and programs encourage indigenous women to deliver in hospitals and clinics, with little regard for their traditions and cultural values. This initiative draws on both indigenous and biomedical knowledge and practices to improve maternal and newborn health without detriment to indigenous cultures. A pilot randomized controlled trial took place in Nancue Ñomndaa communities of this rural indigenous municipality from 2009 to 2012. We designed the intervention together with traditional midwives and intercultural health brokers.

Cultural safety

Cultural safety is a core strategy reaching beyond avoiding harm, to promote cultural resilience, intercultural dialogue, and knowledge exchange with mutual respect. We work with indigenous communities in Guerrero to assist well-established traditional midwives to share their knowledge and skills with a younger generation through apprenticeship. Our hypothesis is that birth outcomes from traditional midwifery are not inferior to what official medical services offer indigenous women in Guerrero State.

The intervention

  • Stipends for traditional midwives and apprentices
  • Stipends for intercultural health brokers to interface between traditional midwives and the health system
  • Building simple community birthing centres where requested by midwife.

Trial outcome measures

Indigenous fieldworkers carried out an impact surveyIndigenous fieldworkers carried out an impact surveyIndigenous fieldworkers carried out a survey to evaluate the impact of the study. Outcome measures we are analyzing include:

  • Antenatal checkups
  • Complications during pregnancy
  • Presence of support at birth
  • Birth location
  • Complications during delivery
  • Birth position
  • Postpartum infections
  • Neonatal mortality
  • Delivery cost
  • Domestic violence during pregnancy.

A larger trial in Mexico and in Colombia seeks to confirm that this culturally respectful way of doing things does not add risks to pregnant women, while it does carry substantial social benefits.

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