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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!