By Louisa Reynolds in Guatemala City
Indigenous midwives are estimated to attend almost two-thirds of the births in Guatemala, and their work has proved vital in the recognition of indigenous peoples’ medicine. But while they play a key part of the process of coordination between the networks of traditional health care and the official health system currently taking place throughout the country, the Western system has yet to fully adjust to including these ancient and respected traditions.
Juana Ajquejay Batz, 45, is a midwife, or comadrona, who has spent over 15 years helping to give birth to children in the municipality of Patzicia, in Guatemala’s central highland department of Chimaltenango. She says that as long as there are no complications, home is the most appropriate place to receive a new member of the family.
“Women prefer to give birth at home because that is where they can prepare the necessary arrangements using their own things,” said Ajquejay Batz. “Accompanied by their mother and husband, with their other children close by, this allows them to remain calm.”
Her work begins with a prenatal check-up, during which she reviews the conditions of the home and advises the parents-to-be of space and the possessions that will be required for the birth. She tries to involve the father in the pregnancy process, and guides the mother on prenatal nutrition. She evaluates the position and growth of the fetus within the womb.
During labor, she communicates safety and trust and calm to the mother, providing her with hot infusions of chamomile, lavender and cumin, helping her to remain warm and relaxed, which makes it easier to push strongly.
Within Mayan culture, birth is a “cold process. The “hot-cold” dichotomy is very important in Mayan culture. When the baby is born, it is leaving the warm environment of the womb to come out into the cold, so it should be balanced out by a warm environment in which the woman feels wrapped up and has access to warm drinks.
Ignored by Western medicine
But although these elements are considered important to assure the woman’s well-being during labor, health centers do not take them into consideration. For example, Mayan families believe the placenta plays an important role and should be burned and later buried in an appropriate place in order to ensure the mother’s adequate recuperation and the health of the newborn child. However, this practice is not accepted within the protocols of the national health system.
Ajquejay says that when she detects a complication during birth, the first problem is to convince the families to take the woman to a health center. When they arrive at the center, the medical staff prohibits her from accompanying the mother-to-be.
“When you try to explain to the doctor what is going on, he doesn’t even listen to you and on top of that he even blames you for what has happened,” she said.
For the National Indigenous Women’s Alliance for Reproductive Health, and other Mayan organizations, the respect of home births is the first significant step taken by Guatemala’s health centers toward recognizing the value of traditional Mayan birthing practices.
The protocols of the national health system are being revised in order that women can decide which position they prefer to bring their children into the world, one of the first task of the Indigenous Peoples and Intercultural Health Unit, created in November 2009.
Meanwhile, the Ministry of Public Health and Social Welfare, known by its Spanish initials MSPAS, is re-fitting its delivery rooms and training its staff accordingly.
Various organizations are demanding that all Guatemalans should have access to health services that are well equipped and respectful of different ways of giving birth.
Although they recognize that the MSPAS has made progress in integrating the two health care systems, indigenous midwives want their expertise be fully recognized and that they be included within the country’s reproductive health services at all levels of medical attention.
The organization argues that the cultural relevance of its work means that the state should establish a professional registry for its members and set aside a budget to pay them accordingly and promote an exchange of experiences and respectful relations between healthcare personnel trained in Western medicine and indigenous therapies.
Lourdes Xitumul, director of the new Indigenous Peoples and Intercultural Health Unit, says that progress is being made and that the rule about home births is already being applied in primary care centers and regional hospitals, but that city or specializing hospitals women are still not given the choice of how to give birth.
Guatemala still has one of the highest maternal mortality rates in the world, and alongside Bolivia it has the highest rates in Latin America. According to the World Health Organization, 290 women die out of every 100,000 live births, meaning that Guatemalan women are 20 times more likely than Costa Rican women to die from birth-related causes.
In Guatemala indigenous women are three times more likely than non-indigenous women to die in pregnancy or giving birth. According to the MSPAS, the mortality rate for the former is 211 per 100,000 pregnant women, and for the latter 70 per 100,000 live births. The predominantly rural indigenous regions suffer the highest rates.
Although maternal mortality cannot always be avoided, the risks can be greatly reduced with appropriate access to emergency obstetric care. One of the main complications that can present itself during birth or immediately afterward is hemorrhaging, which can occur in the absence of emergency centers and an accessible road network; the lack of a blood bank program; and the prohibitive cost for most families of accessing medical services and efficient transportation.
However, it is not just a problem of resources. One of the main difficulties experienced by indigenous women trying to access health care services is the language barrier, which leads to disinformation, increased risks, and disrespectful or even humiliating treatment when they attend health centers.
In fact, various studies have shown that one of the main factors that leaves women vulnerable to an increased risk of maternal mortality is the lack of quality or culturally relevant care that they receive.
This has led many indigenous women to refuse access public health services throughout their pregnancies and post-partem, even when it might save their lives. —Latinamerica Press.