Evolution of Maternity Practices in Ancient Andean Cultures to Modern Peru

In the pre-Hispanic world of Peru, maternity was deeply intertwined with a magical and religious worldview. Pre-Hispanic medicine was primarily magical and religious, lacking the scientific elements of modern medicine. The process of childbirth and conception was considered a magical and religious event, with rituals and care for the mother, fetus, placenta, and umbilical cord. Despite its magical-religious nature, pre-Hispanic medicine also held valuable knowledge based on experience, which can still be observed in the traditions of the Andean and Amazonian peoples.

In the Amazon region, childbirth practices are steeped in tradition. Women give birth in a traditional manner, hanging from a tree branch and delivering with the assistance of their husband or a matron, often their mother. This unique approach to childbirth reflects the deep cultural and spiritual connections of the indigenous communities in the Amazon.

The customs in the Andean region closely resemble those of the jungle due to the fact that the origin of the Andean people can be traced back to the jungle.

Dr. Angela Brocker, a specialist in natural childbirth, has extensively studied ancient medicine practices of jungle communities.

During childbirth, women in the Amazon seek secluded places like the forest or river to connect with nature and the divine, practicing water births for a more intimate experience.

In Los Angeles, women often give birth near the hearth in the kitchen, prepared with necessary elements for childbirth and postpartum care, emphasizing a 30-40 day period of care for the mother and baby.

Spanish chroniclers of the 16th century paid little attention to the medical customs of ancient Peruvians, focusing more on practical matters and showing bias against topics related to maternity and pregnancy.

Ceramic art, particularly from the Moche culture, provides insights into maternity practices with realistic depictions of childbirth scenes and mother-child interactions, shedding light on ancient Peruvian traditions.

The Andean culture historically practiced vertical childbirth, standing or squatting, which is now recognized as a physiological approach even in modern maternity practices, showcasing the wisdom of ancient Andean traditions.

The common practice of giving birth in a horizontal position can be traced back to the late 17th century when Julien Clement, a physician of the French Royal Court, first applied this technique. It originated from the medicalization of childbirth, where historical doctors associated childbirth with surgical procedures performed on a horizontal table.

In Inca society, women would acclimate newborns to cold temperatures by immersing them in cold water after birth to strengthen their muscles. They would breastfeed their babies three times a day while lying next to them, avoiding carrying them to prevent them from getting used to being held. The noble women led a pampered life, leaving all household chores to servants, while in rural areas, women would give birth in the fields during work, washing the newborn in a river and continuing their tasks immediately.

Andean women surprised Spanish chroniclers with their physical strength during childbirth. They would give birth without screaming or showing acute pain, contrasting with the behavior of Spanish women during labor. This resilience impressed chroniclers like Cieza de León, who noted the calm demeanor of Andean women during childbirth.

Andean childcare practices were described by ethno-historian María Rostrovsky based on chronicles. Babies were placed in rough cradles with four legs, one shorter for rocking. Their arms were tied for the first three months. Indigenous chronicler Felipe Huamán Poma de Ayala's drawings depict babies tied to these cradles.

The Spanish conquest traumatized the Andean people, leading to changes in maternity practices. Pre-Hispanic customs and beliefs were banned as superstitious and related to witchcraft. Indigenous women were deprived of their children, who were taken for hispanicization and Christianization, especially girls for future marital alliances.

In the mid-16th century, the University of San Marcos was founded in Lima. Medical education began around 1600 with lectures on primary, secondary, method, and anatomy. However, there was no differentiation in treating women's diseases or the physiological process of childbirth. Children were viewed as small adults.

Obstetrics was considered a minor branch of medicine in colonial times. Childbirth in cities was mainly handled by midwives due to the deficient academic training of physicians, who prioritized rhetoric over anatomy and physiology. The church's influence and reliance on dogma hindered medical progress.

A colonial legacy was the use of wet nurses, robust women who breastfed newborns. It was believed that breastfeeding weakened women, so substitutes were sought, often among Afro-Peruvian women with abundant breast milk. This practice created a social structure as these wet nurses formed sisterhoods.

In colonial society, breastfeeding practices were influenced by social status and mortality rates. Women of lower social classes and in Europe often hired wet nurses to breastfeed their children, associating breastfeeding with inferiority. The ability to afford a wet nurse was a sign of prestige and status. Additionally, high maternal and infant mortality rates led to complex rituals and godparent relationships to ensure care for children who lost their mothers.

During the Viceroyalty period, there was a high birth rate but also a significant infant mortality rate. The demographic history highlighted that increased pregnancies led to higher infant mortality rates. Emotional defense mechanisms prevented parents from forming strong bonds with their children, with some children not even being named until they survived critical moments. Medical advancements and enlightened ideas emphasized improving newborns' quality of life, shifting focus to maternal breastfeeding over wet nurses.

In the 18th century, Dr. Hipólito Unánue, a prominent figure in American sciences, advocated for medical students to receive obstetric education. Concerned about untrained midwives handling childbirth, he revolutionized medical education by introducing courses in anatomy, surgery, and medicine. Influenced by Enlightenment ideas, Unánue emphasized the importance of physicians overseeing childbirth to address high infant mortality rates and population growth challenges.

Dr. Hipólito Unánue, inspired by Enlightenment ideals, believed that medical professionals should manage childbirth to address population growth issues in a sparsely populated country. He recognized the link between a nation's wealth and its population size, aligning with mercantilist theories prevalent in 18th-century Europe. Unánue's efforts to professionalize childbirth and unite the roles of physician and surgeon aimed to reduce infant mortality rates and elevate the status of medical practitioners.

In the early 19th century, the practice of surgery in Lima was not popular among criollos or peninsulares. This led to the assumption of surgical duties by lower castes. In 1826, Hipólito Unánue's ideas materialized with the founding of the Casa de Maternidad and the College of Partos, directed by French midwife Benita Cadó de Fesel at the Hospital Espíritu Santo in Lima.

Madame Benita Cadó de Fesel, who studied at the National School of Midwifery in Paris, aimed to professionalize obstetrics in Lima. She criticized local birthing practices, such as the use of forceful methods like shaking the mother or making her perform erratic movements to hasten childbirth.

The Casa de Maternidad in Lima was known as a 'nomadic hospital' due to its frequent relocations. It moved from the Hospital Espíritu Santo to various locations like the Hospital Santa María de la Caridad and the Hospital Santana, finally settling at the former Hospital de Santana during the Chilean occupation of Lima.

In 1836, Madame Cadot de Fessel returned to France, leaving the Casa de Maternidad in the hands of her disciples and Dr. Francisco Faustos. Her notable work was recognized when the Proto-Medicato General del Estado granted the title of Maestras Parteras to her first five students. Subsequent directors like Camilo Segura Cordero and Rafael Benavides Roa continued the institution's legacy in the 19th century.

The aftermath of the war with Chile prompted a reevaluation of Peru's population and healthcare. The defeat led to discussions on repopulating Peru, colonizing new areas, and reducing infant mortality rates. This period saw a second wave of professionalization in obstetrics, with doctors increasingly involved in childbirth.

In the late 19th century, advancements in obstetrics such as the use of forceps, anesthesia, and increased focus on hygiene elevated the status of obstetrics. Men started to take an interest in the field, with more male doctors dominating the practice of childbirth. Midwives, or matrons, traditionally learned through practical experience from their mothers or grandmothers, gradually acquiring empirical knowledge and skills like using specific plants and preparations to ease childbirth.

In 1881, the maternity house was relocated to the Santana hospital, ending a series of moves between different locations. Subsequently, in 1922, the Santana hospital moved to the maternity house's premises, and later in 1922, the Santana hospital relocated to a new site known today as the Archbishop Loaiz Hospital. Despite being named the Obstetric Gynecological Institute by Dr. Enrique Febrezodresola, the maternity house remained at the Santana hospital's facilities, becoming known as 'the maternity' by locals.

Dr. Enrique Febrezodresola played a pivotal role in achieving autonomy for the maternity institution, which had previously been part of another hospital. In 1924, Dr. Febrez successfully established the maternity as an independent entity, separating it from its previous hospital affiliation. This marked a significant milestone as the maternity institution began operating independently.

A sculpture, often mistaken as a symbol of maternity, located at the former Santa Ana hospital site, was crafted by an Italian artisan who was deaf and mute. Despite being known as the 'maternity sculpture,' it actually represents charity. This sculpture has been a prominent symbol of Lima's maternity for many years, featured in publications and photographs, although its true significance lies in charity rather than maternity.

Dr. José Hipólito Larrabiur Ugarte assumed the directorship of Lima's maternity in 1930, holding the position for a record 20 years until 1950. During his tenure, three significant events unfolded at the maternity. In 1937, the first segmental cesarean section in Peru's medical history was performed by Dr. Víctor Manuel Basul. This groundbreaking procedure was conducted on a 15-year-old girl named Felipa Otárola, who recovered successfully. Additionally, in 1939, the maternity witnessed the cesarean birth of the world's youngest mother, Lina Medina Loza, at the age of 5 years, 7 months, and 21 days.

In 1943, the institution was officially renamed as the Hospital de la Maternidad de Lima, a title that had been informally used for decades. Six years later, in 1949, a groundbreaking medical achievement took place at the hospital with the first complete exanguino transfusion in Peruvian medical history, performed on a neonate suffering from hemolytic disease of the newborn.

The Hogar de la Madre clinic, dedicated to maternal and infant health care, was established following a recommendation from the Second Pan-American Women's Conference held in Lima in December 1924. The clinic was founded to provide protection and care for pregnant women, aligning with the conference's objectives to improve maternal and child health.

On Mother's Day in 1945, the Hogar de la Madre was inaugurated on a 4,000 square meter land donated by the Moreira Paso Blanco couple to commemorate their wedding anniversary. The location is near the intersection of Aramburú and Petituars avenues in Miraflores.

In 1949, on another Mother's Day, the maternity pavilion was inaugurated, donated by the Peruvian Relief Committee for Children, a branch of the International Relief Committee. This expansion marked the strengthening of Rosalía de la Valle's dream.

The Maternidad de Lima, now known as the Instituto Nacional Materno Perinatal since 2005, continues its commendable work adapting to the changing times.

In 2005, a ministerial resolution approved the technical norm for vertical birth with intercultural adaptation, aligning with physiological principles that advocate for a squatting position during childbirth.

Globally, there is a natural childbirth trend, including water births, music-enhanced births, and family involvement, reflecting a return to culturally appropriate childbirth practices seen in indigenous and Amazonian traditions.

The Casa de Nacimiento Pacari, led by Ángela Brocker, advocates for vertical and water births, aiming to dispel fears around pregnancy, childbirth, and parenting through workshops supporting couples from conception to postnatal care.

Placing the newborn on the mother's chest immediately after birth fosters a gentle transition from the maternal womb, providing warmth, familiar sounds, and a smoother detachment, emphasizing the importance of balancing empirical knowledge with medical science for a positive birthing experience.

The program pays tribute to all mothers in Peru, especially those involved in its production, highlighting the importance of celebrating motherhood and the efforts of all individuals in creating the program.