Midwives seek to expand in N.M.
Chronic low pay, skepticism from health care field create hurdles for traditional service
In New Mexico, midwives have been part of the maternal health landscape since before statehood, rooted in Indigenous and Hispano traditions and the work of curandera-parteras — traditional Hispanic midwives.
For centuries, these healers and midwives were the main maternity providers. More than 800 parteras practiced around the state in the early 20th century.
In more recent times, however, the U.S. medical establishment has mounted stiff resistance to certified nurse midwives — skilled and licensed professionals who know how to safely deliver babies — arguing they should not be allowed to take the lead in childbirth care. The failure to integrate them into the health care system reflects an ongoing power struggle: Physicians seeking to protect their turf tend to distrust and misunderstand them, advocates and providers say.
The benefits of midwives, meanwhile, are documented worldwide.
Midwife-led maternity care lowers the rate of neonatal deaths, stillbirths, preterm births, C-sections and low birth weight among infants, studies conclude. It can also significantly reduce maternal mortality.
Nevertheless, midwives participate in only about 10% of U.S. births. In some states, they face restrictions and complex regulations that block their ability to practice or get a license.
New Mexico embraces midwifery more than most. Midwives are involved in roughly 1 in every 4 New Mexico births, more than double the national rate, according to the Department of Health. But they are chronically underpaid.
Similar issues hamper the state’s doulas — nonmedical professionals who offer guidance and emotional and physical support before, during and after childbirth. Some hospitals don’t allow doulas inside their labor and delivery units, advocates say. And doulas aren’t eligible for Medicaid reimbursement.
To address some of these problems, the Biden administration last year called for increased investments in midwives and doulas, along with numerous other actions to combat the U.S. maternal mortality rate — the highest of any high-income nation in the world.
In New Mexico, an increased use of midwives could significantly improve the maternal health crisis and reduce the high rate of maternal deaths, advocates say. In a state where
1 in 3 counties is considered a maternal health desert — and
1 in 3 women has gone without early prenatal care — midwives are considered crucial to bridging the gaps.
Change is slow to come, however, and some midwives and doulas say their existence is at risk. Searchlight New Mexico set out to hear from them firsthand. The interviews have been edited for length and clarity.
Over her 40-year career, certified nurse midwife Jeanne Stagner has had a front-row view of the deepening maternal health care crisis. Originally trained in El Paso by an Indigenous partera, she has lived in Las Cruces and moved back nearly seven years ago to serve the bicultural community.
Year after year, Stagner says hospitals kept increasing the patient load, to the point where she felt the numbers were unsafe. “You are expected to see 25 to 30 in a day. You can’t [do it] without risk of poor outcomes,” says Stagner, who is also a family nurse practitioner.
In 2020, she founded Organ Mountains Family and Women’s Health, joining the ranks of the roughly 270 midwives in the state today who provide services in hospitals, birth centers and homes, according to the Department of Health.
Her own home serves as a health center. Her daughter’s old bedroom became a birthing room, where doulas and loved ones are welcome. A former studio was transformed into an examination room for moms and infants.
Eighty-five percent of her clients are on Medicaid, Stagner says. But the state’s low reimbursement rates and the high cost of malpractice insurance have put her at a crossroads. Providing labor and delivery services is so costly, “I’m at risk of having to shut down.”
Given all the expenses, she says she’s essentially working for free for two months out of the year.
But Stagner knows what it’s like to suffer with subpar health care; it’s made her determined to serve the community. “I was driven by my lack of good treatment to be a part of the solution,” she says, sitting across what used to be her family living room. “I didn’t feel like I had a choice.”
Nandi Hill moved to New Mexico from Chicago more than two decades ago to work as a licensed and certified professional midwife, which until 2022 was illegal in Illinois.
She founded the Wadada Midwifery Care in Albuquerque in 2012 and is one of the few Black certified professional midwives in New Mexico, someone who especially works with Black families, she says.
She also serves people in rural areas, including Indigenous patients from Gallup, which lost a labor and delivery unit in a local hospital last year.
Some Gallup families travel 140 miles to Hill’s practice in the Nob Hill neighborhood.
“We do more than just take care of the pregnant person and the baby,” she says. “We also give advice to grandma, grandpa. How are they doing? How are they healing? Do they need some herbs? Do they need some medicines?”
The low pay is a challenge. On average, prenatal care appointments at hospitals last about 15 minutes, Hill says. Midwives, by comparison, dedicate an average of 45 minutes or more per appointment. But they’re not reimbursed for all the time spent.
Another issue: Medicaid traditionally pays for postpartum care at six weeks — but midwives like Hill conduct multiple checkups before then.
After the birth, “I’m back in the house at 24 to 36 hours,” she says. “I’m back at their house at three days. I’m back at their house at seven days and any time in between. I’m back at their house between 10 and 15 days. I’m back at their house at four weeks and I’m back at their house at six weeks.”
She’s had to secure a second job in a midwifery program at a technical college in Wisconsin to support herself, Hill says. “I still do it because I’m passionate about it, but it is hard.”
In New Mexico and nationwide, a large number of deaths occur during pregnancy and postpartum because of a lack of access to mental health services, suicide or a substance use disorder.
After a birth, “Who’s looking out for the mom? Who is checking on her mental health, who is she talking to?” says doula Melissa Lopez, the executive director of the New Mexico Doula Association.
Lopez, who is Latina, says the NMDA set out to build a network of doula providers of color, especially to support low-income patients and women of color who are trying to navigate pregnancy, lactation, miscarriage or an abortion. She has also been training with Stagner to become a midwife and hopes to open a new birth center in Doña Ana County.
“We used to live in villages, we used to live in community. Our comadres, our sisters, everybody would come over to help each other,” she says. “In today’s world, the way that we live and post-COVID, there is no village. We lost access to so much.”
Doulas can offer the emotional support people are missing, she says. “We’ll watch the kids so you can take a bath or nap or go to the gym because you’re gonna go crazy.”
Along with other wide-ranging advice, they also offer guidance on mental health services. The goal, Lopez says, is to have the least amount of trauma and the most positive experience possible.
There’s been a positive culture shift when it comes to doulas, says Jessica Lujan, who spent more than a decade as the manager of the Indigenous Women’s Health and Reproductive Justice Program at Tewa Women United.
“Groups of doulas,” she says, “are working together and tackling larger issues.”
Today, Lujan is a reproductive justice advocate and the founder of Colibri Corazon, a community-based herbal center north of Española. She and other doulas also conduct trainings and meet with midwives and doctors in Española and Taos to build trust.
Doulas, she says, are making sure that families receive wraparound care and “that they themselves as doulas are providing that wraparound care to each other.”
Meria Loeks gave birth to all three of her children at home, something she wanted other women to be able to experience. In 2019 she opened Santa Fe Birth Center to offer services for home births, prenatal and postnatal care. Annually, less than 2% of births in New Mexico are home births, statistics show.
New Zealand, Norway and the Netherlands have some of the highest percentages of midwifery in the world — and the lowest maternal and infant mortality rates. In the United States, it’s a different story.
“We are still a minority that needs to be protected,” said Sunday Law, a licensed midwife from Truchas. “If the best outcomes come from this type of care, let’s increase [it], legalize midwifery and educate more midwives.”
Mari González has had three high-risk pregnancies in the past two decades; one of her daughters was born prematurely at 29 weeks.
For years, she couldn’t understand why the problems kept happening, she said.
Every time she went to prenatal appointments, the provider was different. The process felt rushed and she always left feeling confused. “You spent more time waiting for the appointment than with the doctor,” she said in Spanish. She decided to look for a provider who could tailor care to her needs.
During her third pregnancy, in 2021, she finally connected the dots: She found Stagner, who discovered through blood tests that González had untreated anemia and gestational diabetes — highrisk conditions for pregnancy. With Stagner’s guidance, she and the rest of the family switched to healthier food.
In May, she gave birth to her fourth child, who was born healthy. She says working with Stagner has done wonders. Midwives provide crucial information and give you “control over your body,” she says.
“Emotionally you are more calm because you know that she’s someone who knows you.”
Searchlight New Mexico is a nonpartisan, nonprofit news organization dedicated to investigative reporting in New Mexico.