Traditional birth attendants and folk midwifery

Domain XI · Traditional medicine & indigenous healing

What it is

This is not a psychotherapy. It is a family of living, community-based birth traditions: traditional birth attendants (TBAs) in many low- and middle-income countries, parteras tradicionales in Mexico and Latin America, and Indigenous midwives in Canada and elsewhere who are reclaiming birth for…

Format

• The traditions have no common phase model. The framework below organises the psychotherapist's own work across the perinatal timeline. Session counts are illustrative, not from a manual.
• CFI timing: the core CFI has 16 questions in four domains. The DSM-5 field trial found later interviews "required less time", but no time in minutes has been verified.

Who practises it, and how they are trained or regulated

• WHO and health systems. The 1992 WHO/UNFPA/UNICEF statement treated TBAs as an interim measure while professional care for all women was built up. It also said their caring, personal approach and their responsiveness to cultural and spiritual needs should be preserved. The 2004 WHO/ICM/FIGO statement says TBAs "cannot replace the need for all women to have care from a skilled attendant" and that TBA training has not…
• Indigenous midwifery (Canada). NACM represents over 140 Indigenous midwives. It states that it is "not a governing or regulating body". Its framework is meant to be adapted by each community and Nation, with Elders and Knowledge Keepers as advisers and teachers. It "purposefully does not include any traditional teachings". Training routes include apprenticeship with practising Inuit midwives, whose certification is…
• Mexico. NOM-020-SSA3-2023 was published in the Diario Oficial in March 2025 and took effect on 1 September 2025. Federal authorities say it places midwifery in the first level of care. It allows a person giving birth to be accompanied by their "partera tradicional de confianza" (trusted traditional midwife) in midwifery houses and low-risk birth units. IMSS estimates about 21,597 parteras nationwide, of whom 6,527…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• The partner as a source of danger: see 4.15. It is working when relatives describe warning signs in their own words.
• Withdrawal if the client feels her attendant is being criticised. Frame the referral as adding safety, not replacing her attendant.
• Helplessness and anger about discrimination; validate these and turn them into small steps. It is working when practical stress falls.
• Coercion or control framed as tradition, or violence. If the client seems unable to speak freely with the relative present, see her alone.
• Shame or fear of being reported. Signs of physical risk (see 4.9). It is working when the client brings the attendant's advice into sessions herself.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.