RIO TALEA, Mexico — Alone in her one-room cabin high in the mountains of southern Mexico, Ines Ramirez Perez felt the pounding pains of a child insistent on entering the world.

    Three years earlier, she had given birth to a dead baby girl. As her labor intensified, so did her concern for this unborn child.

    The sun had set hours ago. The nearest clinic was more than 50 miles away over rough terrain and inhospitable roads, and her husband, her only assistant during a half-dozen previous births, was drinking at a cantina. She had no phone and neither did the cantina.

    So at midnight, after 12 hours of constant pain, the petite, 40-year-old mother of six sat down on a low wooden bench. She took several gulps from a bottle of rubbing alcohol, grabbed the 6-inch knife she used for butchering animals and pointed it at her belly.

    And then she began to cut.