This research highlights the importance of midwives and their recognition as entities for the protection of rights and intercultural health in the community of Cachi Alto, Cotopaxi province, in the central Andean highlands of Ecuador. Ancestral midwifery in Ecuador faces a dialectical tension between its 2008 constitutional recognition and the institutional barriers of the National Health System. This study analyzes why the practice of midwifery is not fully recognized as an intercultural right, exploring the working and social conditions of midwives in the Cachi Alto community. Using intercultural, rights-based, and systemic approaches, the study analyzes the "dialogue of knowledge" between ancestral wisdom and modern medicine. The methodology, based on a community engagement project of the Technical University of Cotopaxi (UTC), employed in-depth interviews and focus groups with experienced midwives from the Cachi Alto community. The results obtained are part of the Community Engagement Project of the Technical University of Cotopaxi (UTC) - Ecuador, entitled "Community Circles for Mental Health." These results highlight the complexity of the ancestral practice of midwifery, given that these women are in a situation of invisibility and, consequently, lack recognition of the value of these ancestral practices. The objective of this article is to make visible the work carried out by midwives in their communities and to understand the obstacles that hinder the recognition of their actions as a right. The study concludes that Social Work should act as a strategic mediator to make these ancestral processes visible. To prevent the loss of this intangible cultural heritage, the State must go beyond symbolic certification and move towards genuine and equitable integration that respects Indigenous worldviews and protects the reproductive rights of Indigenous women in rural areas.