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Innovative Program Makes Skilled Obstetric Care More Accessible in Remote Guatemalan Communities
by Erin McCarthy
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Nurse-midwife called to check on expectant mother during the night. |
A training program being developed by the USAID-funded Calidad en Salud program, managed by URC, is placing skilled birth attendants in the remote Mayan communities of Guatemala. Under the USAID program, URC is working in close partnership with the Guatemalan Ministry of Health (MOH) and the National School of Nursing to train 120 Mayan auxiliary nurse-midwives to detect the obstetric complications that cause high rates of maternal mortality throughout the country and most especially in the country's remote and underserved areas.
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Mayan auxiliary nurse-midwife provides prenatal care. |
Guatemala has one of the highest rates of maternal mortality in Latin America and the Caribbean, with 153 maternal deaths per 100,000 births. In the country’s remote highland areas, that rate climbs to 221 per 100,000 births. More than one-half of maternal deaths occur the day of delivery and 21 percent in the following week, with postpartum hemorrhage the primary cause of death.
Research has shown that most of these deaths could be averted with timely medical care. In the underserved Mayan communities, women have little or no access to skilled birth attendants and they, their families, and caregivers often are not able to recognize warning signs of maternal complications in time to reach skilled clinical services. Cultural barriers also prevent women from reaching critical care in time; even where health services are accessible and free, most Mayan women choose to deliver at home with traditional midwives. Travel conditions which make it difficult to reach hospitals or skilled clinical care centers add to critical delays in accessing quality medical care.
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Mayan auxiliary nurse-midwife accompanies traditional midwife
to prenatal care visit. |
The training program for the Mayan auxiliary nurse-midwives has been developed to address the root causes of high maternal mortality rates in Guatemala’s remote rural areas. The eight-month program combines clinical training with discussions of how to make maternal care more consistent with aspects of Mayan culture. Integral to the success of the program has been the trust and confidence that the auxiliary nurses have inspired in local midwives. The nurse-midwives are trained to instruct and supervise traditional birth attendants, provide quality pre- and post-natal care, and more effectively attend births. Perhaps, most importantly, the nurse-midwives are able to quickly detect signs of complications and to refer patients in time to receive the critical medical care they need. In addition, the nurse-midwives are working with families and traditional caregivers to train them in recognizing warning signs and with communities to establish emergency procedures to transport patients to health centers and hospitals.
Initial data from the program show that the nurse-midwives who have been placed so far have referred over 300 women to clinical services. The nurses have worked with community emergency committees to facilitate timely transfer of women with complications, thereby addressing another significant obstacle to appropriate medical care.
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Group of 21 Mayan auxiliary nurse-midwives at their graduation from the National School of Nursing. |
So far, 88 auxiliary nurse-midwives have been certified by the National School of Nursing and are now employed by Guatemala’s Ministry of Health; another 32 are currently being trained. The criteria on which the initial group of men and women were selected for training included education, ability to speak a Mayan language, and display of commitment and leadership skills. These individuals have been placed in largely isolated indigenous communities where a common language is spoken and where modern obstetric techniques remain largely unaccepted and transport to emergency care difficult.
The program continues to gain in credibility as the MOH incorporates the position of Mayan auxiliary nurse-midwife into its salaried structure and has committed to training more auxiliary nurse-midwives. The Gynecological and Obstetric Association of Guatemala recently recognized them as honorary members of their Association.
For more information on URC's work in Guatemala, please contact Erin McCarthy at emccarthy@urc-chs.com.
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