Rituals and knowledge of Andean midwives in maternal and neonatal care.

Introduction: This study examines the persistence of the knowledge and rituals of Andean midwives within a context of medicalization that has progressively delegitimized ancestral knowledge systems and traditional forms of maternal and neonatal care among rural Quechua-speaking populations in Ayacucho, Peru. The study is framed within the contemporary challenges of global maternal health and intercultural healthcare in Indigenous communities. Objective: To analyze how the knowledge and ritual practices of Andean midwives shape maternal and neonatal care and how these practices are articulated with biomedicine. Method: A qualitative ethnographic approach was employed, based on in-depth interviews with 20 participants: 8 traditional birth attendants, including seven women and one man, 7 mothers, and 5 community actors involved in maternal and neonatal care. Data collection also included participant observation and field notes conducted in rural communities of Ayacucho. Results: The findings reveal a therapeutic system grounded in thermal-body balance, the use of medicinal plants, family accompaniment, ritual practices, and the intergenerational transmission of knowledge. Tensions with the biomedical system were identified, characterized by processes of partial delegitimization, communication barriers, and selective adaptation between traditional and institutional healthcare systems. Discussion: The knowledge of Andean midwives constitutes a living system of care that ensures comprehensive attention, cultural continuity, and community trust during pregnancy, childbirth, and postpartum care. Their recognition and integration into intercultural health policies are essential for reducing healthcare disparities and strengthening maternal and neonatal care in rural Indigenous societies.