In Guatemala, a Comadrona is a traditional birth attendant with little formal education or training. They usually have very few supplies, difficulty transporting patients during an emergency, and oftentimes work in unsanitary conditions. In Guatemala, Comadronas who have little or no formal education attend 80% of all childbearing indigenous women. Guatemala has one of the highest maternal mortality rates in Latin America, with national figures reported to be between 156 and 270 deaths per 100,000 live births.
The Comadrona Project with Helps International works to reduce infant and maternal mortality in rural Guatemala through the training of these traditional birth attendants by midwives, obstetricians, and/or nurses. These trainings take place in the Comadronas’ communities and use visual and participatory curriculum to teach healthy birth practices and emergency response. The Comadrona Project is undergirded by the belief that training the traditional birth attendant in Guatemala, where the vast majority of births are attended by unskilled providers, remains a necessary component of decreasing maternal and infant mortality in this region. The emergency methods we teach are critical to survival until the woman and/or baby reaches a referral facility.
In October of 2011, a Comadrona Training Team made up of Five Iaomai volunteers and led by Dr. Stephen Hebert came to Guatemala to train 11 Comadronas in Huehuetenango during four days. The year prior, a smaller Iaomai team had met with these same Comadronas and gave a brief training during two mornings. We saw the need to extend the training to be more detailed and complete so Dr. Hebert worked hard during the past year to organize the training and find donors that would give materials for the Comadrona birth kits. The 11 Comadronas that we trained varied in age from 15 to 65. We had 3 generations of Comadronas: Grandmother, Mother, and Daughter. Esterfina was the oldest most experienced Comadrona in the group and her granddaughter Nayeli was the youngest and has not yet attended a birth. It was amazing to see these 3 generations of Comadronas with such pride and passion for their profession.
Normally, the Comadrona team would travel from the Military Base in Huehuetenango to the Comadronas’ community; however, Dr. Hebert had slipped a disk in his back and was advised not to travel on bumpy roads for long periods of time. After talking with the Comadrona coordinator, we agreed to transport the Comadronas each day from their community to the Military Base and back. In order to get to the training, most of the Comadronas had to walk anywhere from an hour to two hours to a river. This river is big and deep and there is no bridge for vehicles, just a small footbridge. From the river, Erin Treinen, Helps’ Preventive Health Program Coordinator, would drive the Comadronas 30 minutes to the MilitaryBase. And in the afternoon, she would drop them off at the river to begin their long trek home.
Our training began on Tuesday morning, talking about what the Comadronas had experienced during the past year with their patients: how many complications they had seen, how many transports they made, and what materials were useful. After a long discussion and some icebreakers, we talked about preparing the birth area and sterilizing equipment. We watched the Helps International Comadrona videos on preparing for the birth. After that, we simulated the process by washing our hands and sterilizing the equipment, step by step.
The following day we had Beth Muser, RN specialized in neonatal resuscitation, train on stimulating the baby, mouth to nose/mouth resuscitation, feeling for pulse, and compressions. We watched the Helps International Comadrona video on Helping Baby Breathe and then simulated the process with the Comadronas. Beth had brought a CPR baby simulator so the Comadronas were able to practice all of these techniques on the baby. They also learned how to feel for the pulse and to recognize a normal and abnormal pulse.
On Thursday, the training focused on complications. First we discussed warning signs during pregnancy focusing on bleeding and symptoms of high blood pressure. We then talked about blood loss and used “bloody” towels to demonstrate normal and excessive blood loss during the birth. This demonstration was very impactful because the Comadronas really understood how much blood is too much by seeing the amount on the towels. We also touched on retained placenta as it is one of the most common complications in the area. After lunch, we took a field trip to Casa Materna, a clinic for pregnant women nearing their due date that are high risk. The clinic has beds for women to stay for up to weeks at a time. Casa Materna has nurses working around the clock and doctors who do consults during the day. It is located right next to the National Hospital so when the women have dilated 4 centimeters, they are transferred to the hospital to give birth. Many Comadronas knew of Casa Materna before but had never visited so they found it beneficial to have a tour and ask questions about services provided and cost.
The last day of our training we had all the Comadronas come to the hospital for a medical consult with the Iaomai team. After each Comadrona was seen, we had a celebratory lunch in which we all thanked each other for our efforts and participation. Then we had a “graduation ceremony” in which the Comadronas were given a diploma, a group picture, and their backpack filled with materials for attending births. The birth kits included: scissors, bulb syringe, towels, gloves, soap, nail brush, floss, plastic tarp, baby hats, bleach, container for storing sterilized instruments, and a poncho. The training group and the Comadronas were very happy with how the week went and we look forward to visiting with them in 2012.
By
Erin Treinen
Coordinadora de Salud Preventiva
HELPS International
