AVAC, New York, NY, USA.
Optum, SeaTac, WA, USA.
Glob Health Sci Pract. 2024 Oct 29;12(5). doi: 10.9745/GHSP-D-24-00057.
More than half of births among Indigenous women in Guatemala are still being attended at home by providers with no formal training. We describe the incorporation of comadronas (traditional midwives) into casas maternas (birthing centers) in the rural highlands of western Guatemala. Although there was initial resistance to the casa, comadronas and clients have become increasingly enthusiastic about them. The casas provide the opportunity for comadronas to continue the cultural traditions of prayers, massages, and other practices that honor the vital spiritual dimension of childbirth close to home in a home-like environment with extended family support while at the same time providing a safer childbirth experience in which complications can be detected by trained personnel at the casa, managed locally, or promptly referred to a higher-level facility. Given the growing acceptance of this innovation in an environment in which geographical, financial, and cultural barriers to deliveries at higher-level facilities lead most women to deliver at home, casas maternas represent a feasible option for reducing the high level of maternal mortality in Guatemala.This article provides an update on the growing utilization of casas and provides new insights into the role of comadronas as birthing team members and enthusiastic promotors of casas maternas as a preferable alternative to home births. Through the end of 2023, these casas maternas had cared for 4,322 women giving birth. No maternal deaths occurred at a casa, but 4 died after referral.The Ministry of Health of Guatemala has recently adopted this approach and has begun to implement it in other rural areas where home births still predominate. This approach deserves consideration as a viable and feasible option for reducing maternal mortality throughout the world where home births are still common, while at the same time providing women with respectful and culturally appropriate care.
在危地马拉，超过一半的土著妇女的分娩仍然由没有正规培训的提供者在家中接生。我们描述了在危地马拉西部农村高地的生育中心中引入传统助产士的情况。尽管最初对生育中心存在抵制，但助产士和客户对其越来越感兴趣。这些生育中心为助产士提供了机会，可以继续在家中、在类似于家庭的环境中、在有大家庭支持的情况下，遵循祈祷、按摩和其他尊重分娩重要精神层面的文化传统，同时提供更安全的分娩体验，在生育中心可以由经过培训的人员检测到并发症，可以在当地管理，或及时转介到更高一级的医疗机构。鉴于在地理、经济和文化障碍导致大多数妇女在家中分娩的环境中，这种创新的接受程度不断提高，生育中心代表了减少危地马拉高产妇死亡率的可行选择。本文介绍了生育中心日益普及的最新情况，并深入了解了助产士作为分娩团队成员的角色，以及她们作为家庭分娩的替代选择，对生育中心的热情推广。截至 2023 年底，这些生育中心共照顾了 4322 名分娩的妇女。没有在生育中心发生产妇死亡，但有 4 名产妇在转介后死亡。危地马拉卫生部最近采用了这种方法，并开始在其他仍然以家庭分娩为主的农村地区实施。这种方法值得考虑，作为一种可行的选择，可以在全世界范围内减少产妇死亡率，在那里家庭分娩仍然很常见，同时为妇女提供尊重和文化上适当的护理。
