Comparing Childbirth
Practices in Santiago Atitlán,
Guatemala
Connections, Variations, and Conflicts in
Traditional and Biomedical Obstetric Care
Melissa Gadilla
Dr. Claudia Valeggia
Health 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% nonindigenous
• Site of major state-sponsored
violence during the country’s 36year 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!