Comparing Childbirth Practices in Santiago Atitlán, Guatemala

Connections, Variations, and Conflicts in Traditional and Biomedical Obstetric Care

Melissa GadillaDr. Claudia ValeggiaHealth and Societies

April 27, 2011

Two Birth Stories• Magdalena’s and Chonita’s birth experiences• Magdalena gives birth at home with Antonia, a

77 year-old traditional midwife (comadrona)• Chonita gives birth at the free birth clinic in

the Centro de Salud with a physician and two auxiliary nurses

• Narratives to represent present day obstetric practices in Santiago Atitlán

Background: Santiago Atitlán

• Located in the western highlands of Guatemala in the state of Sololá

• Population: 44, 220 inhabitants

• 98.18% Maya Tz’utujil 1.82% non-indigenous

• Site of major state-sponsored violence during the country’s 36-year Civil War

• Severely affected by Hurricane Stan in 2005 causing hundreds of deaths and homeless

Social Context • Economy of agriculture,

fishing, and tourism• More than half of all

families in Atitlán earn less than $200 a month

• The “Exclusion of the Maya”

• Disparities that inflict Atitecos today contingent to their history and strong sense of cultural retention

Maternal Mortality in Guatemala• Guatemala has the highest rate of maternal mortality (MM)

in Central America and third highest in Latin America

• ~ 290 deaths per 100,000 live births

• 80% of childbearing women are attended by a traditional birth attendant

• Department of Sololá has the 3rd highest MM rate in Guatemala

• MM profile: “A woman of indigenous background, with little or no education, who intended to give birth at home with a comadrona.”

Medical Pluralism in a Tz’utujil Culture• Coexistence of two medical systems:

traditional medicine and a biomedicine

Traditional Medicine • Historically, most widely-used system

• Composed of traditional healers (curanderos) and traditional midwives (comadronas)

• Hierarchy of resort today continues to be skewed towards traditional medicine

• Group of ~28 comadronas

• Informal women’s health system: assist women throughout all stages of pregnancy and treat issues related to gynecological care

Profile of the comadrona

• Unclassifiable and heterogeneous • Generally an older woman, often with

minimal or no schooling, who lives in the community and is recognized for her experience caring for pregnant women”

• Vary in process of selection, formation, and reproduction

• No formal training

Biomedical Community• Lack of strong centralized health care system

model trickles down to smaller villages like Santiago

• Biomedical community:• Centro de Salud with integrated birth clinic• Hospitalito Atitlán• Rxiin Tnamet• Prodesca• Private doctors

• Not a consolidated community• United by the “Red de Salud”

Research Questions

What factors influence the childbirth practices of traditional midwives and physicians in present day Santiago Atitlán?

• Connections: Where comadrona meets doctor

• Variations: Where health models diverge• Conflict: Disagreement between caregivers

Methods• Participant Observation– Midwifery training sessions– Traditional pre and postnatal care, labor and

delivery– Volunteer at Centro de Partos (birth clinic)

• Semi-structured and Structured Interviews– Comadronas and biomedical practitioners – Questionnaire

• Apprenticeship – A student of midwives

Topics Explored

• Where obstetric knowledge comes from• Intents of collaboration:

• Biomedically-directed midwifery trainings• Incorporating midwives into biomedical

settings

• Defining the “Birth Space”• Role of Caregiver

Results

• Empirical vs. non-empirical knowledge• Marking birth priorities• Why incorporating comadronas did not

work• An intermediate “birth space”• Challenging a traditional model of birth

Conclusion

• Connections• Variations

• Driving forces: a midwife’s experience and spiritual guidance and a physician’s biomedical background

• Conflict • Midwives expect normal births, they do

not treat pathologies

Further Implications

• Establishing effective partnership• Sustainability of public birth clinic• Intermediate space as “layover”

location • Ability to choose care

Thank you!