Remaking the Guatemalan Midwife: Health Care Reform and Midwifery Training Programs in Highland Guatemala

Abstract

Midwifery practice and identity in Guatemala is constantly being transformed because midwives must negotiate their practices in response to changing international and national health care agendas and processes. Recently, the Guatemalan government implemented the Sistema Integral de Atención en Salud (SIAS). Framed by neoliberal processes and global reproductive health paradigms, SIAS is designed to attain the reproductive health goals outlined in the 1996 Peace Accords by reducing maternal and infant mortality rates. As the primary birthing specialists in rural areas, midwives are essential to this task. A central focus of SIAS is incorporating midwives into the national health care system through midwifery training programs. Drawing on observations of midwifery training programs and interviews with midwives in the municipality of San Martín Jilotepeque, I argue that the incorporation of midwives into SIAS is redefining the position by establishing a new model of recruitment to the role, education, and practice and authority.

Focus Group with Guatemalan Traditional Midwives about Postpartum Hemorrhage

“…The cost of this boat trip is equal to the average wage for two days (Maupin, 2009) even though many villagers are not employed. In fact, finances are so limited that many midwives do not receive payment for their services, confirming what is in the literature (Maupin, 2008) and what was repeated by midwives in the focus group. Instead, Kek Chi natives tend to exchange goods and services through a barter system rather than from a monetary system.…”

“…Additionally, training programs are taught in Spanish with written materials, despite the fact that many traditional midwives are illiterate and speak Mayan dialects (Hinojosa, 2004;Roost, 2004). Finally, government training programs are based on a medical model as recommended by the World Health Organization (WHO, 2009), managing PPH with oxytoxic medications to help the uterus contract and transferring patients to hospitals for obstetrical problems (Goldman & Glei, 2003: Maupin, 2008. Practicing the medical model is unrealistic for many traditional midwives because the midwives live in remote areas lacking reliable and timely resources, such as oxytoxic medications and transportation to hospitals (Cosminsky, 2001).…”

Mixed methods evaluation & teaching with Guatemalan traditional midwives’ regarding nursing interventions to manage postpartum hemorrhage

“…The cost of this boat trip is equal to the average pay for two days [24] even though many villagers are not employedt. In fact, finances are so limited near Sarstun that many midwives do not ask for payment for their services, underscoring what literature findings [10] and what midwives repeated in the focus group. Instead, Kek Chi natives tend to rely on a barter system to exchange good and services rather than in a monetary system.…”

“…Villagers elect midwives to their posts due to their special talents. Thus, midwives feel honored to hold their positions as public service [10] .…”

“…Additionally, training programs are conducted in Spanish with written materials without consideration that most traditional midwives are illiterate and speak Maya dialects [4,8] . Finally, government training programs are based on a medical model recommended by the World Health Organization [9] that relies on oxytoxic medications for uterine contractions and on transferring patients to hospitals for obstetrical emergencies [5,10] . Most traditional midwives cannot practice a medical model because many live in remote areas that lack reliable and timely resources, such as oxytoxic medications, and transportation to hospitals [11] .…”