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.182Initially, IHD officers thought that they could profitably hire middle-class nurseseducated in hospital-based schools in Mexico s larger cities, for their influence willundoubtedly gradually radiate from the urban centres as has been the history ofpublic health nursing development in the [United] States. 183 Soon, however, itbecame clear that nurses would have to be trained specifically to serve in ruralareas, because few middle-class city girls could be attracted to work in provincialtowns.Beginning in 1932, public health nurses joined health officers and sanitaryinspectors in six or eight-week courses in RF-supported field training stations.Within fifteen years almost a thousand nurses had been trained in these courses.Still, RF officers complained perennially that nurses were of low cultural standing and that training in Mexico was primitive. 184 In spite of these laments, reliance onvisiting nurses grew over time.Without explicitly conceptualizing the visiting nurses as a women s initiative,the IHD-DSP health units as did countless health departments in Europe,elsewhere in Latin America, and the U.S.185 engaged in cross-class andg' 162 goi ng localg'gender-specific strategies, using working-class (though preferring middle-class)nurses to bring poor, rural women into the medical fold.As guided by unitdirectives and their own experience, nurses employed a mixture of incentives,coercion, reprimands, and warnings.The common thread was that expertknowledge, imparted either in the health unit or in the home, should replacecustoms and superstition around maternal and child health.Trained nursesrepresented medical and class authority, and gender affinity facilitated thereception of this authority.These efforts, while challenging existing socialstructures in rural Mexico, were consistent with many of the goals of therevolutionary Mexican state, whereby a growing professional class includingwomen nurses would enable social and economic modernization across thecountry.Midwives as MidwivesThough nurses and to some extent teachers served as a female-friendlyextension of the health units, rural communities already enjoyed an existing setof women healers midwives.Having promised to target infant mortality, theunits had little choice but to ask local midwives (parteras) to carry out a servicethat the units themselves could not fulfill delivering babies and providingongoing care to new mothers.While curanderos (traditional healers, both maleand female)186 had been swept aside as superstitious witches, the sanitary unitssought to incorporate midwives through medical training and supervision.Indoing this, the IHD-sponsored units whether consciously or not were adapt-ing their public health model to the local reality.The units were also entering along-standing controversy around the training of midwives in Mexico.In addressing pregnancy, infant care, and midwifery, the health units wereentering territory that had previously been the domain of women.The units jus-tified their encroachment by linking Mexico s high infant mortality to maternalignorance and the erroneous practices of midwives, who attended over 90 per-cent of births.187 Infant mortality, estimated at over 200 deaths per 1000 livebirths, offered, according to the 1934 Annual Report of the Rural HygieneService, evidence of the need for medical care and supervision for the expec-tant mother and the infant.Infant mortality rates in towns with sanitary unitswere lower than the national average, but still high, ranging in 1934 from 88deaths per 1000 live births in Tuxtepec, Oaxaca to 145 deaths/1000 in PuertoMéxico.188The 1934 report went on to complain that many women, through ignoranceor economy, prefer empirical midwives who charge little, creating a grave dan-ger for both mothers and children. Because they did not restrict their activitiesto childbirth, midwives were also blamed for posing prenatal and postnatal dan-gers.It was thus necessary to identify, monitor, and train midwives in order to goi ng local 163Disclaimer:Some images in the printed version of this bookare not available for inclusion in the eBook.To view the images on this page please refer tothe printed version of this book.Figure 3.13.Members of the midwife club, equipped with satchels filled withscissors, soap, silver nitrate ampules, sterile tape, forceps, and other instruments,pose with the Cuernavaca health unit director, 1933.Courtesy of the RockefellerArchive Center. give them a sense of responsibility and to place limits on their work so theywould not threaten the lives of mothers or their children. 189Beginning in the early 1930s, instead of displacing them, the units sought totransform scores of empirical traditional midwives into modern childbirthattendants by paying them to attend weekly midwife clubs. At the Cuernavacaunit, for instance, midwives were pressured to attend classes so that the Doctorcould instruct them in less dangerous birthing practices. This training in obstet-rics and midwifery, as one doctor noted, consisted mainly of instruction in whatthey should not do. It also allowed doctors to monitor midwives, because fornow it is impossible to get rid of them and it is worthwhile to recognize this situ-ation and attempt to educate them in order to minimize the harm they cause. 190In traditional Mexican settings, the midwife ticitl in Nahua served as chiefadvisor, spiritual guide, and caregiver to women during pregnancy, childbirth,and the post-partum period.191 Many midwives believed they answered a divinecalling, and virtually all underwent apprenticeships to learn both ritual and clin-ical practices.Midwives, typically respected older women, provided continuouscare through all phases of birth, earning the confidence of expectant and newg' 164 goi ng localg'Disclaimer:Some images in the printed version of this bookare not available for inclusion in the eBook.To view the images on this page please refer tothe printed version of this book.Figure 3.14.Midwives being trained in modern childbirth methods, Cuautlahealth unit, 1936.Courtesy of the Rockefeller Archive Center.mothers.Although specific practices varied from culture to culture and fromindigenous to mestizo communities, historians and anthropologists have docu-mented numerous overlapping patterns.Prenatal care involved observing thecolor of the nipples.the shape of the womb, and the position of the fetus, andrelieving physical ailments through massage and herbal remedies.Childbirthusually took place at home in the presence of the expectant mother s family.Traditionally, women gave birth in a kneeling or squatting position, aided by theforces of gravity.During difficult deliveries, midwives sometimes employedherbal medicines and gentle massage.The umbilical cord, not cut until the pla-centa was expelled, was normally cauterized with a candle flame or cut with aheated blade.In the weeks following the birth, the midwife aided the newmother with household chores, offering both emotional and physical support.Within a few weeks after delivery (and sometimes during pregnancy and theearly stages of childbirth), the new mother took one or more temazcalli thera-peutic steam baths which served to physically, ritually, and emotionally cleanseher.192 Midwives and their patients believed the baths increased the flow of milk,prevented illness, and helped adjust the balance of hot and cold influences.193Sanitary unit training sessions, on the other hand, were designed to limit themidwife s role to a medical one, discarding social and ritual functions
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