Midwives blend Mayan traditions with contemporary Western medical practices to preserve lives
In the remote communities of Guatemala's western highlands, midwives like Epifania Eliás play a crucial role in reducing maternal and infant death rates. These traditional midwives, many of them Indigenous, provide culturally appropriate, accessible, and often lifesaving care that blends ancestral knowledge with modern medical practices.
Eliás, a 66-year-old midwife, became one herself after delivering her own baby alone on the floor of her kitchen. Today, she is one of at least 22,000 traditional midwives working across Guatemala and 15,000 in Mexico.
Women like Chavez seek out midwives like Eliás due to the lack of advanced medical care or resources to pay a private clinic. In Guatemala alone, comadronas deliver half of the country's births. Chavez's pregnancy had been marked by difficulties due to the region's economy still ravaged by COVID-19.
The Association of Comadronas in the Mam Area (ACAM) travels by bus out to remote communities to provide ultrasounds and prenatal kits, and also constructed a birthing clinic staffed with a handful of medically trained traditional midwives and a doctor who assists in more complex cases.
The work of midwives serves another purpose: to pass on a dying tradition. However, a scarcity of midwives has arisen as younger women turn away from the practice. ACAM was formed 17 years ago to train a new generation, the children of current comadronas, but today, leaders say this training is needed more than ever.
The fight to save mothers and newborns often happens in bare-boned rooms like this one where Chavez is giving birth. The fear of an increase in infant and maternal mortality rates, coupled with patients seeking higher levels of medical care, has resurfaced old tensions between health officials and midwives.
Both health officials and midwives fight for the same goal: reducing maternal and infant deaths. However, they exist on two sides of a cultural chasm. Midwives accuse medical staff of discriminating against them, mistreating their patients, and blocking them from entering medical facilities. Health officials blame comadronas for maternal deaths, accusing them of bringing birthing mothers to hospitals after it's too late.
At hospitals, the workload for midwives has skyrocketed, but the number of expectant mothers doctors treat has decreased. When women do arrive to the hospital during childbirth, they often come on their deathbeds. In high-risk situations, it's those very midwives who often convince women to seek healthcare in hospitals.
If traditional midwives were to disappear, the consequences would be dire. The deaths of many women would occur, and hospitals could collapse from the number of patients. The infant mortality rates in Guatemala are already high, with two of every 100 children dying in birth.
Guatemala has the highest maternal death rate in Latin America, with 115 mothers dying in childbirth compared to the regional average of 87 per every 100,000 births. Programs that train and integrate traditional midwives into broader health systems enhance their skills while respecting their indigenous practices, further contributing to declines in maternal and child mortality rates.
By bridging the gap between rural communities and formal health facilities, traditional midwives help detect and manage complications early or facilitate timely referrals, which significantly lowers death rates for mothers and infants. Their combined role as accessible caregivers, cultural mediators, and links to formal health services is vital in improving maternal and newborn health outcomes in these regions.
- The work of traditional midwives, such as Epifania Eliás and the members of ACAM, blends health-and-wellness practices with historical ancestral knowledge to provide essential, culturally appropriate care to communities in Guatemala's western highlands, contributing to a decrease in maternal and infant death rates.
- Mental-health concerns are often overlooked in these communities, yet midwives like Eliás play a significant role in offering emotional support to expectant mothers and women dealing with various challenges, including those exacerbated by the current economic struggles brought about by the COVID-19 pandemic.
- Women's-health issues are intelligently brought to the forefront through the practice of midwives like Chavez, who help improve maternal and newborn health outcomes in rural areas by bridging the gap between remote communities and formal health facilities, facilitating timely referrals, and managing complications early.
- Science joins forces with tradition to help train a new generation of midwives in Guatemala, ensuring continuity of culturally sensitive healthcare practices while incorporating advances in medical technology and knowledge to enhance the skills of comadronas and contribute to further reductions in maternal and infant mortality rates on the planet.
- By traveling to remote areas for workshops and providing resources like ultrasounds and prenatal kits, ACAM's mission impacts not only the health of communities but also contributes to the preservation and promotion of indigenous traditions at risk of dying out.
