Birth Models That Work

11. The CASA Hospital and Professional Midwifery School: An Education and Practice Model That Works

305 Chapter 11 The CASA Hospital and Professional Midwifery School An Education and Practice Model That Works Lisa Mills and Robbie Davis-Floyd La Misión de CASA [CASA’s Mission] Contribuir con calidad y calidez a elevar las condiciones de vida de la población más vulnerable, a traves de acciones en salud, educación, y cultura, promoviendo el desarrollo sustentable y el respeto a los derechos humanos, con una perspectiva de genero. [To contribute with quality and warmth to elevate the life conditions of the most vulnerable people, through actions in health, education, and culture, promoting sustainable development and respect for human rights from a gendered perspective.] Placard on the entry wall of the CASA School for Professional Midwives, Colonia Santa Julia, San Miguel de Allende, Mexico INTRODUCTION1 The CASA maternity hospital and professional midwifery school are unique in Latin America, perhaps in the world. The Centro para los Adolescentes de San Miguel de Allende (Center for the Adolescents of San Miguel de Allende) (CASA), in the state of Guanajuato, central Mexico, has developed both birth and midwifery education models with concrete practicality and a judicious combination of science and caring. CASA is a nonprofit health and social service agency offering diverse services that focus on the needs of disadvantaged youth and women. It was established in 1981 by Nadine Goodman, an American-born social worker and public health specialist. It has received consistent funding from several international, primarily U.S.based , foundations (Friedland 2000). The CASA program began by offering contraceptives and family planning services provided through peer counseling programs throughout the state of Guanajuato. From the start, Nadine’s 306 l. mills and r. davis-floyd vision included choices for women across the reproductive spectrum: the choice when to have children, the choice of how they would be born, and choice about how they would be cared for when mothers had to work. Thus in 1994, in response to the lack of local reproductive and maternal health services offering such choices, CASA opened a maternity hospital with the intention that it would eventually be staffed primarily by midwives, whom Nadine saw as the only caregivers fully equipped to provide true choice in birth. In 1997 CASA opened Mexico’s first professional midwifery school, La Escuela de CASA de Parteras Profesionales (the CASA School of Professional Midwives ). The CASA campus now provides a range of reproductive health care services, as well as dental, pharmacy, and laboratory services. It operates a day care center to care for the children of working families in its region, a large public library, and a youth ecological awareness team, and it also has formed a theater group involving local adolescents, who perform dramas dealing with gender issues such as domestic violence. CASA has approximately 100 paid staff and 300 volunteers; its family planning and reproductive education services reach tens of thousands of people per year in San Miguel and surrounding regions (see www.casa.org.mx). CASA also has a live weekly radio program run by young people and midwives, and its programs are rebroadcast to a potential listening audience of more than 5 million through a network of nineteen government-funded Indigenous radio stations. The CASA midwifery school trains professional midwives (parteras profesionales ), most of whom plan to live and work in rural communities that currently lack medical services and where most instances of maternal death occur. The CASA midwives are imbued with the woman-centered philosophy known internationally as the “midwifery model of care” (see Rothman 1982; Davis-Floyd 1998; Conclusion, this volume), and the CASA educational model ensures that their care will be not only woman-centered but also culturally appropriate. This model of care represents an alternative to the biomedical model practiced in Mexico, which is unnecessarily interventionist (Castro 1998; Castro, Heimburger, and Langer n.d.) and in rural areas and among the urban poor is often experienced as disrespectful and insensitive (Espinosa Damián 2004). As part of their professional training, the CASA midwifery students leave San Miguel and go into rural areas to apprentice with traditional midwives (parteras tradicionales)2 for periods of two or three weeks at a time, five times during their three-year training program. These terrenos prácticos are intended to equip CASA graduates with the cultural literacy required for practice in such communities, in synthesis and combination with the professional midwifery and medical literacy necessary to augment traditional knowledge. During these rotations, the student observes and learns from a...