Help Maya Midwives Save Lives in Rural Guatemala

The Covid pandemic has overwhelmed Guatemala's public health system and left many pregnant women feeling isolated, highlighting the need for our Maternal Health Program navigators, who accompany women on their journeys and provide a variety of supports along the way.

From July 2020-June 2021, midwives and navigators with our Maternal Health Program have monitored 769 births and saved 31 lives by identifying potential problems in pregnancy and connecting mothers with the care they need to avoid further complications.  

Doña Ana's story is just one example. 

At the time of her fourth pregnancy at age 31, Doña Ana, a field worker from a village outside Tecpán, was living in fear of her husband. He was controlling and verbally abusive, especially when he was drinking. Several years earlier, she had put her first child, whom she had with a former partner, under the care of a relative out of concern for the child’s safety.

Because Doña Ana had a Cesarean delivery with her last child just over a year earlier, workers at the local health post advised her to seek medical care during her pregnancy to address potential risks and to consider another Cesarean delivery. She was reluctant to do so, fearing that it would provoke her husband, who did not like her to leave home. Working with our care navigators, Doña Ana was able to get her husband’s agreement to see a doctor at the Tecpán Health Center and schedule a Cesarean delivery.

A month later, she developed pain in one of her legs and went for an evaluation at the Health Center. The doctor indicated that if the pain persisted, she should go to the hospital and seek emergency care. In a follow up call, our team noted the possibility of premature labor and advised a hospital visit. In calls over several hours, our team attempted to convince Doña Ana’s husband to allow his wife to seek care at a hospital, but he refused to allow her to leave the house before dawn.

Early the next morning, Doña Ana, who continued to experience pain, met our care navigator, who had been waiting for her at the hospital. With sadness, she revealed that she had left the house secretly. Communicating through the navigator, who translated from Spanish into Doña Ana’s language of Kaqchiquel, the gynecologist indicated that Doña Ana should be admitted for treatment to stop labor since she was just 27 weeks into pregnancy. Doña Ana broke down in tears, sharing her fears that her husband would not agree to the treatment. After repeated unsuccessful attempts to contact her husband, Doña Ana agreed to have the navigator reach out to her mother-in-law. The mother-in-law expressed surprise and concern, approved the hospitalization, and agreed to speak with her son. After being released, Doña Ana let the navigator know that things were ok with her husband upon her return home.

A couple months later, Doña Ana again began experiencing labor pains before her scheduled delivery. Thanks to her earlier experiences, she understood that it was important to get help regardless of how her husband might respond. But when a doctor suggested that she should be admitted for treatment of an infection, Doña Ana again began to worry about her husband and about care for her children who were at home. Fortunately, this time, when she spoke with her husband, he said he supported the treatment and agreed to care for the children at home. Crying tears of relief, she agreed to stay.

Three weeks later, after waiting at the hospital with several shifts of navigators for more than 24 hours, Doña Ana gave birth by Cesarean delivery to a 6-pound 4-ounce boy. Today, she is enormously grateful for her healthy new baby and for the support and care she now receives from her husband. She credits her work with our team for teaching her the value of her own life.

Links:

• NIH: Developing Mobile Health Solutions for Women in Guatemala

Here in Guatemala, the pandemic continues to pose a serious threat to both individuals and the health care sector. Only about 3% of the population has received any vaccination and less than 1% is fully vaccinated. Thankfully, our Maternal Mobile Health Program continues to overcome barriers and provide life-saving care to mothers and infants. 

Our midwives, who are trained local Mayans, meet patients where they are at, socially, culturally and importantly physically. They travel to expecting mothers to lead them through home births when possible, and when not, arrange for transport to local hospitals, where our navigators help guide them through the healthcare system. 

This program serves several communities and many women. One recent patient was  23-year-old Doña Irma, who had had a bad experience in the hospital delivering her first child and was planning on delivering her second at home. A midwife attending her at her home noted that Doña Irma was not in labor although she was past 40 weeks pregnant and her water had already broken. The midwife communicated with our emergency team, who coordinated a plan to get Doña Irma to a local hospital for a safer delivery. 

Despite severe rain, we were able to safely transport Doña Irma to the hospital along with one of our navigators. Doña Irma mostly speaks the Mayan language Kaqchikel, which complicates healthcare for her as most Guatemalan doctors only use Spanish. Luckily, navigators from the Maternal Mobile Health Program were there to translate and advocate. 

 Ultimately, Doña Irma avoided a C-section and other complications, and gave birth to a healthy baby. Doña's Irma’s two hospital birthing experiences stand in sharp contrast. With her first child, Doña Irma was in the hospital alone, struggled to communicate with doctors, and felt scared. The second time around, she felt supported, comforted, and was able to better advocate for herself with our navigators’ help.