Changing roles and identities of midwives in rural Costa Rica

The roles and social identities of rural midwives in Costa Rica reflect the changing history of local birth practices vis-à-vis pragmatic local needs as well as the changing relation of the nation-state to the production of birth. This article explores how midwifery practices changed over time in relation to Costa Rican state policy and why prenatal massage (an important element of prenatal care historically) retains its importance despite the massive hospitalization of birth. Home birth's history as a heterogeneous, flexible model for care, combined with the pragmatic needs of women, make midwives and prenatal massage central in the production of hospital birth. Costa Rican midwives survive in the interstices of the biomedical model of care, providing interventions demanded by women (although demeaned by biomedicine) and serving as a safety net for pregnancy crises in hinterland communities. While acknowledging the potential for maternal or child death during pregnancy crises in isolated regions, midwives generate acute critiques of the biomedical model of birth and clearly articulate the practical need for (and continuing importance of) their practices in rural areas. This case study illustrates the obstacles to international awareness faced by midwives in so-called Third World countries like Costa Rica-midwives who must overcome not only geographic and socioeconomic marginalization, but also overwhelming opposition from the state and multilateral "reproductive development" policies.