"Women come here on their own when they need to": prenatal care, authoritative knowledge, and maternal health in Oaxaca.

Physiological and anatomical concepts about reproduction held by traditional midwives in Southern Oaxaca differ considerably from those of biomedicine. Government training courses for traditional midwives disregard these deep-seated differences, and also the underlying conceptual rationale of ethno-obstetrics. These courses constantly reinforce and actively promote the biomedical model of care. But rural midwives, despite these training courses, do not substantially change their obstetrical vision and ways. The strength of their own authoritative knowledge, fully shared by the women and men of their communities, allows them to continue their traditional style of care, despite pressures to conform to biomedical values, beliefs, and practices. Suggestions for a mutual accommodation of biomedical and midwifery approaches to prenatal care include training medical personnel in ethno-obstetric techniques and rationales, teaching midwives basic medical interventions, addressing in intervention programs all social actors participating in reproductive decision making, and adopting an interdisciplinary approach that includes nonmedical aspects of maternal care.