Over the course of nine decades, Doña Miriam delivered much of the population of the Costa Rican village of Tres Equis and gave birth to 19 children of her own—all at home, never in a hospital.
Her accumulated wisdom forms the heart of The Last Partera, a documentary making its global debut at Full Frame Documentary Film Festival this weekend. Co-directed by Ned Phillips and Victoria Bouloubasis and produced by Pilar Timpane, all of whom live in Durham, The Last Partera documents and pays tribute to vanishing traditions of midwifery and captures the evolution of those practices with sequences that follow Rebecca Turecky, an American-born nurse midwife who studied with Doña Miriam for 25 years.
The film’s visuals are as rich as the landscape of the Turrialba Volcano that towers over Tres Equis. Birth scenes are filmed in a way that feels both raw and magical, and shots of the village’s natural terrain frame the story within a larger context of regeneration.
Ahead of the premiere, the INDY spoke with the three filmmakers about their seven-year journey making the documentary, the ethics of filming births, and what Doña Miriam’s legacy tells us about the future of women’s healthcare.
INDY: How did you first meet Doña Miriam, and what about her and her work spoke to you as something to center a film around?
PHILLIPS: I was in Costa Rica, house-sitting for some friends. They were friends with Rebecca—she had actually been their midwife. She and I had lunch, and she said, “By the way, I have this mentor that I’ve been learning from for 25 years. Her name’s Doña Miriam. Would you want to meet her?” My documentary brain immediately said yes.
So we went out to her village and had coffee with Doña Miriam. She was exactly who you see in the film—funny, inspiring, wise, warm, and completely captivating. As a documentary filmmaker, you’re always looking for that sort of engaging personality. When I was leaving, Rebecca said, “By the way, I’m having a home birth any day now. Would you want to photograph it?”
I took photographs of this amazing, beautiful, powerful, transformative event. Between that experience and meeting Doña Miriam, I sensed the seeds of a story. When I got back to the States, I cold-called Victoria, told her what I’d seen, showed her some photos, and said, “Would you want to work on this with me?” Though we’d never worked together or really known each other, she agreed.
Had you witnessed a birth before?
PHILLIPS: No. It was my first experience with birth, and not a topic I had much interest in before. It was so beautiful and powerful that I thought other people should see it.
Victoria, what about this project spoke to you? What made you want to jump in on it?
BOULOUBASIS: I had never witnessed a birth either. A few things struck me. I’ve noticed that whenever we see childbirth in the media, it falls into two categories. It’s either comic relief—like in Knocked Up or other Seth Rogen films, where someone’s dramatically giving birth in a taxi—or it’s portrayed as something gross and scary. This project was a way to witness birth and acknowledge it as something beautiful, rooted in a camaraderie of women.
While we live in patriarchal societies everywhere, these microcosms of women leading and supporting each other have always existed. This film is a testament to that tradition.”
Also, my grandmother, my dad’s mom, was a midwife in Greece, in her village. Visiting Doña Miriam reminded me of this connection. I saw many similarities between her and Doña Miriam—their strength, their colorful language, their practicality in doing what needed to be done, and their ability to find humor and celebrate life throughout it all.
As I got to know Rebecca and her relationship with Doña Miriam, I saw how their work rippled through the community. Though Doña Miriam was traditional in many ways, she embodied an inherent feminism (a term she would never use herself). It was about trusting other women and trusting yourself as a woman to accomplish something with the support you need. While we live in patriarchal societies everywhere, these microcosms of women leading and supporting each other have always existed. This film is a testament to that tradition.
Pilar, how did you get involved?
TIMPANE: Ned and Victoria were already working on this for a while, I think maybe even up to a year. I spoke to Ned first about the film and thought it was a beautiful project.
I’ve had both of my children since we started the film, and this encouraged me to learn about all of my possible birthing routes in North Carolina. It was interesting to do this in parallel with working on the film. I think it made me a lot less afraid of birth. Like Victoria was saying, the way that it’s portrayed in culture is like, “This is going to just be the scariest, worst experience.” And I feel like Doña Miriam and midwives like her are constantly trying to normalize this experience and give women a chance to enjoy it and have it be a normal part of our life, instead of being something that we’re meant to fear. And also to do it in community.
That’s a big part of midwifery—having so many people in the room when you’re giving birth actually really helps, because you’re feeling like, what am I going to do without all of this support and this eminent strength around me?
Were there different ways you approached giving birth based on what you learned while making the film?
TIMPANE: Yeah, I wanted them to be attended by midwives. And for myself and my partner to be as involved in the birth of our kids as the midwives and the attendants. Midwifery practice has—and Doña Miriam says it—women are in charge of their own birth. She’s always talking about how you’re not without the wisdom that’s inside of you to be able to do this to yourself.
What perspectives on the relationship between traditional practices and women’s autonomy in healthcare are y’all hoping that viewers might take away from this film?
BOULOUBASIS: That’s a great question. It was also something that we wrestled with a lot during the production process, because the film could have gone in many different directions. There’s a sector of Latin American public health pushing for—they call it parto humanizado, humanized childbirth. We ultimately chose to keep it centered around Doña Miriam and her legacy and influence, because it was a much more personal take on the issue.
This isn’t a film that is divisive about which healthcare is better. It’s very much about the power of knowledge and having women understand their rights in many ways, of choosing how they want to give birth. We wanted to highlight that and also show that there are different ways of performing deliveries—you see Doña Miriam and Rebecca have different approaches. For example, Doña Miriam did not agree with water births.
There’s different ways that whatever Doña Miriam did, and traditionally knew how to do, can evolve. It’s almost like listening to the past and then recreating what works better and modifying it for the present and future. There’s no real “this one’s better and this one’s bad.” As you see towards the end of the film, Rebecca is working with the hospitals and giving them exercise balls and trying to incorporate midwifery practices into the existing system. We want people to see that there isn’t a division in the way these practices work. It’s more of a choice.
I’m interested in how you approached documenting the births, since they’re inherently unpredictable and obviously very intimate. I’m curious logistically how you prepared for them, and if there were ethical considerations you had when documenting such an intimate healthcare practice.
PHILLIPS: We planned our production trips for a specific time, just knowing that there would be pregnant women, because that’s Rebecca’s life. And so it was kind of luck of the draw, who was going to be having her moment during the time we were there. In all the cases, except one, we were able to meet the mothers ahead of time. We were there for their prenatal visits. We shared what we were doing, and told them about Doña Miriam, so they were clued in to the big-picture thing of what we were trying to show and illuminate. They were grateful and excited to have us there, which is crazy, because it’s one of the most intimate moments of someone’s life.
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But we were just very communicative and spent time off camera, and made sure that they knew that we were just there to observe and celebrate, and that if they ever felt uncomfortable or didn’t want us around, we would scram. And then for the birth, it’s kind of like, Victoria and I would be lying in bed in the middle of the night, in our clothes, ready to hop up if—
BOULOUBASIS: I wore jeans to bed for, like, a straight week.
PHILLIPS: It felt like being a firefighter, just on call, waiting for the phone.
BOULOUBASIS: Ned’s behind the camera the whole time. There were times I’d have to back out if the rooms were too small. There were also times where I was helping boil water, cool it down, and put it in the pool. The last birth in the film I didn’t even witness, because I was babysitting her other daughter downstairs with her and keeping her occupied so that everyone else could focus on the mother.
As Ned said, from an ethics and trust perspective, we were able to get to know these women ahead of time. Even though we didn’t include it, we interviewed everybody, and that helped us understand these women better, so we could capture these moments in ways that felt specific to them. I want to also stress that it speaks a lot to the trust that they had with their midwife, Rebecca. They trusted her, so they trusted us.
At one point in the film, we see Doña Miriam in the hospital after suffering a stroke, creating a powerful juxtaposition with her lifelong avoidance of hospitals and medical institutions. How did you approach filming her in that vulnerable situation while still honoring her autonomy? Did you go back and forth on including that part of her story?
BOULOUBASIS: We always thought it was important, for the basic chronology of the story. But also, stories about elders are really important, and they’re often not nuanced, and we didn’t—I mean, she’s a legend, and there’s no denying that, but we didn’t want to portray this completely ethereal being. That was technically a moment of weakness for her, even though you see her strength in that too. And we wanted to show the complexities of aging, and honor her past and those contributions to her community, but also what she was experiencing now.
PHILLIPS: Thematically, one of the things that we talked about from the very beginning, from the very first trip—there’s just this idea of the cycles of life in all capacities. So that’s why there’s so much nature footage. There’s sunrises and sunsets, there’s rain and then there’s sun. These things happen on their own timelines. And human lives are the same. They change and evolve, and they have moments of light and darkness. As new people are coming into the world, people are making their way out. So it’s one of the undeniable forces that we really wanted to make sure that people were seeing, and drawing a parallel between the natural world and the human world.
It seemed like the physical environment really influenced your cinematography and storytelling; all of this playing out at the base of a volcano.
PHILLIPS: When my friend was trying to get me to come house-sit at their house, they mentioned that Turrialba is like one of these places on the map where the compass doesn’t settle, right? It’s this—it’s like Sedona, Arizona, or whatever. It’s magnetic, these mystical places, the ground’s really fertile. Energy healers have been coming here for a long time. So it was laid out to me—I went there in my mind that there was this magical sort of place where all these things are happening. So immediately, Victoria and I talked about the tone, about having—we’ve used the term “magical realism.” I don’t know if that’s really it, but just that there’s something kind of special going on.
And just by the nature of where it is, on the foot of the volcano, it is an agricultural culture. So it is a place that understands and kind of survives understanding and knowing these cycles of life.
The film depicts a group of women launching a brick-and-mortar Holistic Center for Women and Maternity in Costa Rica. What’s the status of that center?
PHILLIPS: Rebecca, along with some other women in Costa Rica, created an organization called Mamasol, which is dedicated to sharing the knowledge of, and preserving, home birth practices and working to push parto humanizado further. Unfortunately, their physical space doesn’t exist anymore, but the organization of Mamasol still does a lot of stuff and has a strong membership. They’re constantly training and educating doulas.
BOULOUBASIS: During Doña Miriam’s day, there wasn’t schooling, necessarily, but Doña Miriam did work at a doctor’s office and was mentored by a doctor, and the government acknowledged and documented the fact that she was a midwife. That no longer exists in Costa Rica, and so—it may have changed, but when we were making the film, there were only three certified nurse midwives in Costa Rica, and only one of them was born and raised in Costa Rica, because their medical school and nursing schools don’t—it’s not easy to go through that process. There’s a reinvigoration happening, and a lot of the doulas have worked in the medical system.
PHILLIPS: This is one of those threads that we briefly tried to follow in production—this idea that Mamasol and the community around it is working really hard to create new legislation and change what’s allowed in the system. But then you’re getting into that kind of movie, which is not what we wanted to do. I think the idea was like, let’s just show you what’s happening, and then hopefully, when that conversation about what’s happening with the laws in Costa Rica comes up, people already have an understanding of home birth and the importance and power of the midwifery model.
TIMPANE: As it relates to our climate in the United States, our country is in a backward momentum of women’s health. There’s evidence that birthing women and birthing parents are less safe as time goes on in our system, so midwifery has never been more important in terms of women’s health, because it’s women’s healthcare that centers women and centers birthing parents as they’re in the process of that. The fact that there’s more and more of a disparity and loss of life in birth and pregnancy means it’s absolutely essential to have knowledge like Doña Miriam’s be a part of our normal culture.
There’s something—a poem, maybe?—that’s read at the beginning and end of the film. I’d love to hear where those words came from.
BOULOUBASIS: Those are two different poems by Jorge Debravo. He’s from Turrialba, sort of like the hero poet of the region, and like everyone knows who he is, the local school is named after him.
PHILLIPS: The landscapes he’s writing about are what we’re actually seeing. The final line of the movie is “At twilight, if you look upon the mountain, it’ll look like the silhouette of a mother.” That’s the volcano that he’s talking about. He said what we wanted to say: This is a magical, historic land where there’s life happening constantly. As always, the poets say it better and with more brevity and beauty than we ever could.
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