May Sanchez on Dixon, 'Delivering Health: Midwifery and Development in Mexico'
Lydia Z. Dixon. Delivering Health: Midwifery and Development in Mexico. Policy to Practice Series. Nashville: Vanderbilt University Press, 2020. 232 pp. $34.95 (paper), ISBN 978-0-8265-0113-4; $99.95 (cloth), ISBN 978-0-8265-0114-1.
Reviewed by Gianna M. May Sanchez (University of Michigan) Published on H-Sci-Med-Tech (December, 2022) Commissioned by Penelope K. Hardy (University of Wisconsin-La Crosse)
Printable Version: https://www.h-net.org/reviews/showpdf.php?id=58004
Lydia Z. Dixon’s Delivering Health: Midwifery and Development in Mexico is comprehensive in its analysis and discussion of midwifery, medical politics, and obstetrics in Mexico. Dixon’s anthropological study of traditional and professional midwives centers on three distinct educational facilities and their place within the medical landscape of birthing in Mexico. Rather than an examination of individual practitioners and their interactions with medical authorities and the state, Delivering Health emphasizes epistemologies and philosophies of how midwives learn their trade and what constitutes midwifery in both traditional and biomedical settings. In so doing, Dixon provides a dynamic and varied view of midwifery that challenges ahistorical depictions of the practice and details midwives' relevance and importance in Mexico today. As she argues, “midwifery persists because midwives occupy an important position in the health-services continuum:... [as] both insiders and outsiders,... [who] hold the potential to bridge the gap between the communities they serve and the health services these communities need” (p. 175). Indeed, rather than existing opposite biomedical practices or in opposition to physicians and the state, midwives within Dixon’s work are constantly present alongside them, working and negotiating their place and the care of their patients throughout.
Delivering Health is organized thematically, based on ethnographic research Dixon carried out in Mexico from 2009 to 2012. In addition to shadowing a few select midwives, Dixon followed the work of three midwifery education centers: the Center for the Adolescents of San Miguel de Allende (CASA), Mujeres Aliadas, and Nueve Lunas. Together, these chapters serve to demonstrate how midwives worked with and against the health-care system in Mexico, including how midwives and educators at these institutions navigated the politics of certification and authority within state modernization efforts and medical professionalization.
The first chapter, “Midwifery in Mexico and Beyond,” addresses the history of the practice of midwifery and obstetrics in Mexico, emphasizing the continued reliance on midwives to meet the medical needs of rural communities in spite of increasing pressure by the state to give birth within biomedical institutions under the care of physicians. Dixon frames this historical outline within the context of CASA’s founder, Nadine Goodman, discussing the vital and lasting significance of midwifery to an incoming cohort of students. Chapter 2, “Breaking Out the ‘Uterus Box,’” continues this thread and acknowledges the work midwives perform as “holistic gynecological care,” that is, prenatal and postnatal care to women extending beyond delivery. This approach, in contrast to biomedical birthing experiences, attends to the health of the newborn while also prioritizing the well-being of the mother as a person in need of holistic care rather than as a vessel to maintain the health of a baby. Chapters 3 and 4 (“Maternal Conditions” and “Obstetrics in a Time of Violence,” respectively) detail the violence and neglect women often face when only biomedical routes are available, resulting in obstetric violence (a form of gender violence) that puts the life of the mother at risk and removes her agency and control over her reproductive autonomy. Within these moments of violence, midwives advocate for their patients and push back against invasive and harmful medical practices. The final chapter, “Modern Tradition,” concludes with a reflection on the concept of “tradition” and the legacy of midwifery, refuting conceptions of midwifery as an atemporal practice removed from the modern day. Instead, it is a dynamic and shifting practice that honors its traditional past and the value of ancestral knowledge, responds to the needs of women in Mexico, and adapts to biomedical trends and pressure from state and medical officials to fit within a paradigm of modern medicine.
Taken together, the depth of analysis for Delivering Health is almost staggering. Dixon often delves into the historical and political debates surrounding obstetrics and midwifery at multiple scales, to the point where, at times, it is possible to lose sight of the educational centers that comprise the book’s focus. What’s more, attention to each facility is uneven, favoring CASA as a point of analysis far more than either Mujeres Aliadas or Nueve Lunas. Dixon is aware of this imbalance, acknowledging that this disproportionate focus reflects the distribution of time spent at each facility during her research. Her research on CASA builds on an existing relationship Dixon maintained first as an intern and then as a researcher prior to her fieldwork. This being said, weaving the narratives of the three facilities together helps to craft a full illustration of the practice of midwifery in Mexico.
The wealth of information that Dixon provides is, in part, a response to the severe lack of scholarship that addresses the history of traditional and professional midwifery in Mexico. As she acknowledges throughout, few studies exist that detail both the history of the practice and its continued use and importance. Delivering Health fills this gap, providing a glimpse into the work of midwives as important health-care practitioners and political figures who advocate for the validity of their work and their patients’ needs. The politics of negotiating space, authority, and knowledge in medicine is prevalent throughout the three institutional case studies, a reflexive position that directors and students often comment on throughout Dixon’s research. In addition to considering the content and implications of the type of education and information midwives in training receive, organizations like CASA are constantly redefining and navigating their role within obstetric medicine in Mexico. They provide medical care to women in need, train future generations of midwives, advocate for improved maternal well-being, and preserve the cultural and historic legacy of midwifery in Mexico.
As a whole, Delivering Health is an engaging read, with a perfect balance of historical analysis, ethnographic narrative storytelling, and theoretic discussion on scholarship and method. Notably, Dixon opens the work with an anecdote about her own birthing experience at CASA, and the rest of the monograph likewise incorporates small moments during her research that both humanize the midwives and deconstruct major themes of the book. In particular, she often describes moments where biomedical and traditional midwifery practices intersect, noting the seeming contradiction and presenting it as a false dichotomy. These moments illustrate how biomedicine and traditional midwifery are not diametrically opposed but instead often blend together to form a system of comprehensive holistic care. It is through such stories that we are able to fully grasp how midwives have navigated their roles as medical practitioners in Mexico, through actions that simultaneously act with and push against state doctrine and biomedical professionalization.
Citation: Gianna M. May Sanchez. Review of Dixon, Lydia Z., Delivering Health: Midwifery and Development in Mexico. H-Sci-Med-Tech, H-Net Reviews. December, 2022. URL: https://www.h-net.org/reviews/showrev.php?id=58004This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.