In her role as academic coordinator at the HRA Cayale Guenda Nabani School of Professional Midwifery, Rafaela López travels to monitor the work of one of her midwifery students in Oaxaca, Mexico. Part of the school’s curriculum requires students to live and work with area traditional midwives, in order to learn, honor and continue their practices. López believes that professional midwifery should combine traditional and biomedical approaches to women’s health. She is not alone. Many women’s health advocates believe combining approaches gives women more options, and the power to choose alternatives appropriate to each woman’s individual needs.

After traveling by bus and bike taxi for two hours, midwife Rafaela López crosses a river in rural Oaxaca, in the final stretch of her journey to reach the student midwives she coordinates, during their semi-annual training at the homes of traditional midwives.

Midwife Rafaela López makes a home visit to check on a pregnant woman in Zoyatlán de Juárez, a small indigenous community located deep in the mountains of Mexico’s Guerrero state and one of several communities where trained midwives from the Guerrero School for Professional Midwives fulfill their post-graduation social service commitment. After six months, she was able to penetrate the hearts of Zoyatlán’s residents. Local women and the community doctor petitioned the Health Secretary to allow her to stay longer, but their earnest request was denied.

Professional midwife Rafaela López performs a pre-natal checkup in rural Oaxaca. A graduate of the Guerrero school of Professional Midwives, López imagined that she would graduate and work in Guerrero as a midwife. When contracts promised by the government were not forthcoming, López decided to move to the neighboring state of Oaxaca to become the academic coordinator for a newly established school for professional midwives.

Near their (then) home in Tlapa de Comonfort, Guerrero, Mexico, Rafaela Elifsep López Juárez (L) and her daughter, Johana, 8, set up to spend a few hours inside an internet café so that López can look for jobs in midwifery. Months after graduating from the Guerrero School for Professional Midwives, she and her colleagues were still waiting for the state education secretary to issue their diplomas and professional licenses (cedulas). Jobs promised to them as midwives in state health institutions were not forthcoming.

Rafaela López’ partner, José Hernández, communicates with the couple’s unborn baby while Rafaela’s daughter, Johana,11, ignores them, inside their home in Xalapa, Veracruz, Mexico. López recalls how José was a bit apprehensive when she told him she had decided on a home birth. As a midwife, López believes that witnessing a birth is a gift and a privilege that can change a man’s life, if he is allowed to participate.

Rafaela López and her partner, José Hernández enjoy walking to the hospital on a beautiful day, in the downtown area of Xalapa, Veracruz, Mexico, where they live. They were on their way to file registration papers at the hospital, to ensure that Rafaela would be able to receive services, should an emergency complication requiring medical attention occur during her home birth. According to WHO statistics, approximately 85 percent of pregnant women should be able to deliver babies naturally, without medical intervention.

Accompanied by professional midwife Pilar Victoria (L), Rafaela López (middle) tries to manage intensifying contractions as her labor starts inside her home, while her partner, José Hernández, takes notes on the timing of the contractions. For López, giving birth at home has numerous advantages, including the freedom to walk and eat when one desires, the option to receive direct support from loved ones and care from a trusted and skilled midwife, the avoidance of routine and painful medical procedures that occur in hospitals, and above all, safety from being exposed to potentially harmful diseases inside hospitals, she said.

Exhausted and exhilarated, Rafaela López rests inside the pool where she gave birth, at her home in Xalapa, Veracruz, Mexico, while her partner, her mother and her midwife help her hold her newborn boy against her skin. In addition to the overwhelming feeling of love she felt on this day, Rafaela said being able to achieve a natural home birth gave her a profound feeling of empowerment and enormous satisfaction.

Rafaela López and her partner, José Hernández enjoy bathing their six-month-old son, Joshua, who was born at their home in Xalapa, Veracruz, Mexico. For López, the notion of a home birth, accompanied by a midwife, is the ultimate expression of agency and empowerment and the ideal scenario for experiencing a dignified, respectful and meaningful birth. She also believes that her partner and daughter were able to create a very deep bond with Joshua because they were able to witness and participate in his birth.

Midwife Rafaela Lopez and her partner, José Hernández, (seated in hammock) and their 6 month-old son, Joshua, enjoy a surprise reunion with Rafaela’s parents and family friends in the small village of Tlalquetzalapa, Guerrero, where they live. Rafaela’s mother had been by her daughter’s side during the home birth of Joshua in Veracruz, but her father had never seen his grandson, until this day, due to travel restrictions necessitated by the Covid-19 pandemic.

Accompanied by her daughter, Johana, and her son, Joshua, Rafaela López returns home after shopping, days after the predicted due date for her third child. As a trained midwife, López knew that walking and moving consistently could stimulate contractions; thus, she tried to stay active and continue her daily activities. She and Johana were filled with emotion after buying diapers, as they anticipated the imminent arrival of the new baby.

Rafaela’s partner, José Hernández Miranda, their son, Joshua Hernández López, and Rafaela’s eldest daughter, Johana Hernández López, play video games, in the company of the family cat, trying to occupy their minds as they anxiously await signs of labor on Rafa’s predicted “due date.” As the day closed, she had felt only a few light contractions. Her ample experience as a midwife helped her remain calm and confident to let the process evolve. Babies should be born when “they decide” she said.

Feeling what she thought were initial contractions the day before her due-date, Rafaela López instructs her daughter, Johana how to perform an ancestral traditional midwifery technique using a rebozo to stimulate pelvic movement and relax muscles to promote correct positioning of the unborn baby before and during labor. Her mother, María Florencia Juárez and son, Joshua Hernández López stayed close to her side. Rafa hoped to give birth at home, surrounded by all of her family members. Her biggest fear was developing an emergency complication that would require hospitalization.

Thirty-nine weeks pregnant, Rafaela López (R) cooks for her family in the one room apartment where they temporarily lived in August, 2022, and where Rafaela gave birth to her third child.

Thirty-nine weeks pregnant with her third child, Rafaela López endures the heat while food shopping with her daughter, Johana (R) and her son, Joshua. As a trained midwife, López knew that walking and moving consistently could stimulate contractions; thus, she tried to stay active and continue her daily activities.

Thirty-nine weeks pregnant with her third child, Rafaela López (L) rests with her legs raised to prevent swelling in her feet, after she and her daughter, Johana (R) had been shopping for food for the family for several hours in the intense afternoon heat. Rafaela gave birth to Johana when she was 17. The two are extremely close, and Johana is always eager to help her mother in any way she can.

Rafaela López Juárez (R), rests after running errands, while her daughter, Johanna, 13, marvels at the movements her unborn sister makes inside her mother’s womb. López gave birth to Johana when she was 17, and the two are very close. Not knowing at the time that other options existed, López gave birth to Johana in a hospital, where she recalls having experienced obstetric violence and unnecessary medical procedures. She later studied to become a professional midwife and has since preferred home birth scenarios where she can feel empowered and respected, she said.

Rafaela López controls the pain of her intense labor contractions through breathing exercises, while her midwife gently pours warm water over her body to relax her as her contractions intensify. As a midwife, López is very aware of the birth process and could thus move through her labor without fear. Midwives like Rafaela consider birth to be a natural process that can occur safely in one’s home while being accompanied by a qualified midwife who knows how to identify risks and when to refer a woman to a hospital to avoid an obstetric emergency.

Rafaela López begins active labor inside her home, while her midwife, Lucrecia Neri (back) and her mother, María Florencia Juárez (R) support her as her contractions intensify. For López, giving birth at home has numerous advantages, including the freedom to walk and eat when one desires, the option to receive direct support from loved ones and care from a trusted and skilled midwife, the avoidance of routine and painful medical procedures that occur in hospitals, and above all, safety from being exposed to Covid and many other potentially harmful diseases inside hospitals, she said.

Assisted by her partner José Hernández and professional midwife Lucrecia Neri, Rafaela López reaches the final stage of giving birth in the comfort of her own home, surrounded by her loving family.

Midwife Lucrecia Neri (R) holds the newborn daughter of Rafaela López and José Hernández, seconds after its birth, inside the couple’s home. Having Neri present was very special for López, since the two graduated together in the same class from the Guerrero School for Professional Midwives. She was also happy that José was present. López believes seeing a birth is a gift and a privilege that can change a man’s life, if he is allowed to participate; yet very few hospitals allow this opportunity. She has also witnessed how experiencing a birth together at home can contribute to making a family more unified.

Rafaela López checks her partner’s forehead to see if he has a fever, the morning after she gave birth in her home, surrounded by supportive family members. Hernández slept on the floor after the birth. He was exhausted after several weeks of looking for work and trying to get the family settled in a new city, but he felt tremendously relieved and overjoyed that everything went well during the birth of the couple’s new baby daughter.