The results from our baseline survey in Xochis and Tlacos revealed that 6 out of 10 women sought traditional midwives for advice and care while pregnant. Among women from remote communities, prenatal care provided by midwives was preferred to care from physicians. Traditional midwives were a protective factor for prenatal care, since pregnant women who sought their advice were seven times more likely to have gone for checkups in government health units. Moreover, obstetric results in homebirths with midwives were not inferior to those from deliveries in hospitals and health centres.

But the baseline also showed that traditional midwifery was slowly fading away in the region: 8 out of 10 midwives were 50 years or older at the time of the survey. The good news was that all of them said they would teach younger women willing to learn how to do their work.

Based on discussions with the midwives, we decided to build a simple birth centre, or casa de la partera in Spanish, as part of the Safe Birth in Cultural Safety intervention, in three of the four intervention communities: Llano del Carmen, Cerro Bronco and Arroyo Grande. Here, they would train their apprentices, assist other women, and attend births. These facilities would also help elderly midwives who had difficulties to visit patients in more remote communities. The midwife in the fourth intervention community, Xochis cabecera, did not request a birth centre since she uses her home for deliveries and training.

Midwives, community health promoters and the CIET team all joined in the discussion about the design of the birth centres. They decided on a design similar to Nancue Ñomdaa homes, which all have similar layout, size and materials. These simple homes have one or two rooms, an outdoor latrine and are made from clay and straw bricks with dirt floors and tiled roofs.

Members of the community joined in the construction of the centres using materials from the region. Once completed, the centres were equipped with supplies chosen by the midwives.

While the new birth centres serve tool for the midwives to continue their practice, they still conduct household visits and home deliveries, accompanied by their apprentices, as far as their age and health.