COP16: Traditional midwifery as an environmental strategy

In the early morning dusk, the room was dimly lit by the faint glow of an old lamp hanging lazily from the low wooden ceiling. Mamamilda, her hands steady and her face calm, prepared her tools for the most important birth of her life.

She had her Pinard bell ready to listen to the heartbeat of the unborn child. The Vaseline, the tape measure and the plastic, carefully spread out on the bed, waited their turn. In a corner, a small pot boiled, releasing the sweet and familiar aroma of toma seca, a concoction prepared to comfort the mother after childbirth.

This natural drink, like alcohol in the medicine cabinet of a Western doctor, is indispensable, and its preparation requires a link between the spiritual and the territorial, hence the call to reflect on the close relationship between midwifery and nature.

"Traditional midwives live and are part of the environment and of medicinal and aromatic plants. We are transversal to everything that nature and Mother Earth have given us," says the 74-year-old woman, who has attended some 350 births and is attending the Biodiversity Summit in Cali.

At the time of this birth, the sticky heat of Buenaventura enveloped the room, but Mamamilda didn't seem to notice. Concentrating, she looked at Lizeth, her second daughter, who was sitting next to Isleany, the mother in labor that night. The 32-year-old woman was breathing heavily, sweat beading her brow, her hands clutching the sheets with the strength of someone clinging to life itself.

Lizeth, her 25-year-old sister, whispered words in her ear to calm her fear, reminding her that her mother was there, that everything would be okay. But not everyone shared that reassurance. Mamamilda's nephew, a young internist, could not hide his nervousness.

He had spent the afternoon insisting that Isleany go to the hospital. "She's had a C-section before," he had warned, his voice full of concern. "This could be dangerous," he had continued. But she had been clear: "I'm going to deliver with my mom."

For decades, as DANE points out in its recent report on traditional midwifery, two systems of care for pregnancy and childbirth have coexisted in Colombia: the formal system, made up of doctors, nurses, and health workers, and the traditional system, made up of midwives and representatives of ancestral medicine.

Despite the existence of these two systems, there is still a profound lack of knowledge about the practices of traditional midwifery, which is often dismissed as a profession instead of being recognized as a discipline that cares not only for the body but also for the spirit of mothers and their children.

Sensing her nephew's discomfort, Mamamilda told him: "When you were born, I was already a midwife; calm down". But even she was not calm. With these words she wanted to evoke the security that she herself lacked. It was her daughter.

In her voice were decades of experience and ancestral knowledge, made invisible and often delegitimized by a health system that for years has ignored the validity of midwifery.

"We use biological and natural resources. Although we are questioned, we know that we do not pollute like Western medicine, which uses plastic waste," emphasizes the woman representing the Association of United Midwives of the Pacific (Asoparupa) at COP16.

A report consolidated by Ideam assures that in 2022, clinical waste will be the one that generates the most pollution in the country.

"We use everything natural, and the most important thing is to reduce violence during childbirth. In Buenaventura, in both rural and urban areas, we are an average of 1,200 midwives," she says.

In this collective, they have promoted the creation of azoteas, a kind of patio or vegetable garden, where they plant medicinal plants and vegetables, some of which they call "power plants" because they contribute to alleviating health problems. They do not destroy ecosystems and try to create natural mixtures with the least possible impact.

"We came to Cali to make a call: that midwifery be recognized as a necessary practice for the care of biodiversity in the Colombian Pacific; it is a traditional practice that upholds the precepts of the majoras, who for centuries have coexisted in harmony and respect with animals and flora," she comments.

"The use of natural resources and the knowledge of the black women for the care of these moments is fundamental. Somehow to preserve the life cycle of the ethnic territories. These women, with their roofs and practices of ecosystem care, are contrasted with invasive activities," says Audrey Mena, deputy director of Ilex, a group of lawyers who work on issues of defense of the traditional knowledge of Pacific communities.

As the birth progressed in Buenaventura, Mamalinda knelt beside the bed. Her vaseline-soaked hands moved with the experience of one who has attended hundreds of births, whispering prayers barely audible over the gasping breaths of her firstborn.

Pinard's bell rested for a moment on her daughter's tense belly as she concentrated on listening to the baby's steady, rhythmic heartbeat. The midwife took a deep breath, as if that certainty comforted her. She looked at Lizeth, who had managed to calm Isleany, and nodded to her. Everything was ready.

The nephew watched cautiously, as if expecting something to go out of control at any moment, but Mamamilda did not hesitate. She showed him how to position himself, what to look for, and what to expect. He was not just observing a birth; he was witnessing the resilience of a knowledge that remains vital in rural and Afro-descendant communities like Buenaventura, where, according to the Dane, 79 percent of births in rural Afro-descendant areas and 95 percent in indigenous communities are still attended by traditional midwives.

This practice has gained visibility and relevance in recent years, thanks in part to regulations such as Decree 356 of 2017 and Resolution 3676 of 2021, which recognize the role of midwives in certifying the vital event, allowing births to be ed without the intervention of the formal medical system.

For Mamamilda, childbirth was not just a physical process; it was a rehearsed dance in which the past, present, and future were woven together in her daughter's womb. Her devotion and care went beyond technique and materialized in small gestures that offered comfort and strength to mothers who, like Isleany, relied on tradition and knowledge ed down through generations.

The nephew, though reluctant at first, found himself absorbed in the way his aunt led with a soft but firm voice while others held her hand and offered encouragement. He knew that many mothers in rural communities faced barriers to ing their children when they were born at home with midwives, as noted in the Danish report.

For years, the unofficial recognition of midwives' work created several obstacles for newborns to obtain birth certificates, leaving them outside the country's legal and social system. However, thanks to new regulations, a change has begun to emerge that s and legitimizes the ancestral work of women like Mamamilda.

The delivery was uneventful, and as Mamamilda held the newborn in her arms, her eyes lit up with pride and relief. The baby cried for the first time in the dim light, a sound that echoed like a promise of life, an echo of resilience and hope. With each new birth she attended, she reaffirmed the importance of a practice that, though often neglected, has proven crucial to the care of life and the preservation of cultural identity.

Despite progress, midwifery continues to face challenges that reflect deep social and cultural inequalities. Much remains to be done to integrate these practices into a health system that, as women say, should learn to see the richness of diversity and recognize that "giving birth with the heart is often the only option".

DEYNER CAICEDO CAMACHO AND DAVID ALEJANDRO LÓPEZ BERMÚDEZ

Special Envoys of EL TIEMPO

Cali