Lessons from one of the last Tica midwives.(Costa Rica)

When I moved to Costa Rica in 1990, after finishing my midwifery intensive training course with a California direct-entry midwife, I had dreamed of meeting a traditional Tica (Costa Rican) midwife and working by her side. I was stunned when I learned that 99 percent of women in the country gave birth in the hospital, with obstetrician-gynecologists or obstetrical nurses. Since the universalization of the nation's socialized health care system in the 1960s, public health clinics and hospitals were made available in even the smallest villages. The traditional, self-taught midwives, known as comadronas or parteras, who had accompanied women in birth for generations, were basically forced into early retirement with the new regulations and limitations enforced by the Ministry of Health. While many women welcomed the so-called safe, modern advancement of the hospital medical model, others resisted the change and continued to knock on the doors of their community midwives until new laws strictly prohibited their practice. The tradition and wisdom of the old midwives has almost died out completely, except in a few rural areas of the country. One feisty midwife, Dona Miriam Elizondo, continued to open her door to those who knocked. At the age of eighty, she still does!

Dona Miriam is loved and repected by everyone for miles around. When I mentioned to my neighbors in Turrialba that I study midwifery, many asked if I had met the famous partera from Tres Equis, a rural town about 45 minutes away. When I got the chance to drive over the mountains and visit Tres Equis, I asked the first person I saw on the dirt road about Dona Miriam. They knew exactly who I was looking for and where to find her. Dona Miriam, or abuelita (grandmother) as she is called by most, was the midwife who helped bring almost the whole town of 2000 inhabitants into the world. I walked up to the porch of her humble wooden house, painted sea-green like so many houses in Costa Rica. The front door was open, but no one was in sight. A sign with a crucifix on the door read Familia Calvo Elizondo, Dios bendiga este hogar (Calvo Elizondo Family, God bless this home). I'll never forget my first impression of this youthful, earthy old woman as she walked out from the side of her yard where she had been feeding the pigs and tending to the garden. Most Costa Rican women of older generations only wear skirts; Dona Miriam wore pants, had her shirt sleeves rolled up to her elbows …