RÉSUMÉ
PIP: A midwifery work exchange project was developed through the coordinated efforts of MADRE, A Us organization that encourages exchange between Nicaraguan and American women as an effort toward peace in Central America, and AMNLAE, Nicaragua,s national women,s organization. The purpose was to exchange skills and information among health care workers and to enhance the role of the midwife in the Nicaraguan health care system. To date, 14 US women have participated in activities including teaching a 6-day midwifery education course, participating in open forums on women's health care issues, teaching health care in the community and workplaces, assisting in the development of childbirth education curricula, and teaching contraceptive technology to physicians and nurses. Follow-up activities were held in the US. Drastic changes in the role of women in Nicaraguan society have occurred since the 1979 revolution. As women have gained more control over their lives in this predominantly Catholic country, they have sought to gain control over their fertility. The US representatives described every possible method of family planning that might be available to Nicaraguan women, including breastfeeding, recognizing signs of ovulation, coitus interruptus, oral contraception, IUDs, and all barrier methods. The importance of the education of men and open discussion by the couple was stressed to increase contraceptive usage. The recognition and education of midwives is seen as a key feature in the improvement of women's and children's health in Nicaragua. The idea of a professionally trained midwife or obstetric nurse was raised through this project, and such a clinician may be developed in the future.^ieng