Childbirth in the Caribbean

Birth justice – obstetric violence – dehumanized care – respectful maternity care – why do we have these conversations?

Globally there are far too many incidents of disrespect and violations to women and their families during pregnancy, labor and birth. Although there is little actual data available the stories are all too familiar. In the Caribbean region, women accessing care are too frequently subjected to a system that does not respect their choices–in life, in their choices of provider and in their choices of care. Often the only time that women enter the health care system is during pregnancy. It is a prime opportunity to offer education and information in many areas–nutrition, exercise, birthing, breastfeeding and parenting. Yet this is not routinely done. Partners and families are not encouraged to participate in the visits during pregnancy.

During labor, Caribbean women are denied food and drink and are not routinely allowed to have a support person present. Fathers are denied the right to be present at the start of their child’s life. Women do not give birth in a position of their choice or, at the very least, in an upright position. The midwife or obstetrician “delivers the baby”. The mother does not birth her baby. There is a relatively high rate of intervention and always active management of the third stage of labour. Babies are not immediately placed skin to skin and allowed to bond and to breastfeed within the first hour.

We, as care providers, must advocate for, and educate families to insist on, changes within the health care system. Better quality care does not mean more machines and equipment or even more staff. That may help, but the human resource is our most valuable asset. While we do need increased numbers of care providers, it is how the care is delivered that significantly influences the quality.

Are we setting up future generations? Until we as a society recognize the enormous impact of the experiences of pregnancy and birth on the long term health of our people the battle must continue. We must educate and empower women and their families, as they identify them, and continue to advocate on their behalf for changes to the existing system. Health care must be safe, accessible, equitable, culturally appropriate, nonjudgmental and woman-centered.

Mamatoto Resource & Birth Centre was founded when four independent midwives began meeting informally to share concerns and to support each other as they faced the challenges in the health care system. They dreamt of a place where women and their families could meet and get the information and support they needed to make the choices for their individual maternity needs. With only their own resources and no to very little support from the medical and financial world this seemed to remain only a dream. The determination of one mother, Renee Etta, who we call our “catalyst”, changed this. After many hours of proposal writing we were able to get funding in 2004 to purchase and renovate the property where the Centre is located.

Mamatoto, the Swahili word for mother & baby, is a non-profit, non-governmental organization with the overall goal of empowering women and their families to make and exercise informed choices with respect to their reproductive health. Our mission is to facilitate women to have a safe, natural childbirth experience.

The Resource Centre provides access to a free, multimedia library with materials on reproductive health and breastfeeding. There are free support groups for teens; post natal families and those with a miscarriage, stillbirth or infant loss. Sessions offered include prenatal yoga and childbirth education.

The free standing, midwifery led Birth Centre offers family-centred care which is individualized to meet each family’s needs and choices. Waterbirths are often requested; a doula is present for each birth and we offer funding assisted care for low income families and teens. In 2015, we assisted 48 births and over 1000 women accessed some aspect of our services.

We also do presentations and workshops to care providers and students on violence in pregnancy, caring for teens and respectful care. The 2015 State of the World’s Fathers Report on family inclusive care refers to a TEDx Talk which I did on Why Fathers Should be Present for Birth. We utilize every opportunity to present &/or have a presence, at, for example, health fairs and expos; schools; church & community groups; and conferences to inform the public on their choices and rights related to maternity care and reproductive health.

Our vision for the future is to have a greater impact on national policy to ensure that the care we provide is seen as the model for all health care in Trinidad & Tobago.


Debrah Lewis CNM, MSc is a founder and current Executive Director of Mamatoto Resource & Birth Centre in Trinidad. Since graduating with a Masters Degree majoring in Maternal-Child Health from Columbia University in 1986, Debrah has worked in public and private practice midwifery in New York, Africa and Trinidad & Tobago. She works with the Ministry of Health and the Nursing Council, and serves as an independent consultant on midwifery matters. Debrah was the International Confederation of Midwives (ICM) Americas Board Member from 2005 – 2011 and Vice-President from 2011 – 2014; a founder and current Executive Member of the Trinidad & Tobago Association of Midwives; and spearheaded the
formation of the Caribbean Regional Midwives Association in 2012. Debrah is the recipient of several awards including the Dorothea M. Lang Pioneer Award in 2012 and in 2014 a National Award for The Development of Women – Gold – for her work in Community Service and Midwifery in Trinidad & Tobago.

Birthing Justice: Black Women, Pregnancy and Childbirth, edited by Julia Chinyere Oparah and Alicia D. Bonaparte is now available in paperback with a free Discussion Guide.