Midwives and Mothers: The Medicalization of Childbirth on a Guatemalan Plantation. By Sheila Cosminsky. 2016. University of Texas Press, Austin. 303 pp (original) (raw)
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Fighting for respect: Midwives and the medicalization of childbirth in Guatemala
PsycCRITIQUES
Although birth is considered one of the few universals of the human experience, Sheila Cosminsky illustrates through its rituals and traditions how childbirth is culturally informed. Drawing on decades of fieldwork in a Guatemalan finca (plantation) and close connections with the two main comadronas (midwives) on that plantation, Cosminsky provides vivid examples of how pregnancy, childbirth, and to some extent motherhood are experienced by those who call the finca home. A central theme of the book is how the medicalization of childbirth-the promotion of hospital deliveries and medical intervention-has left both comadronas and mothers disempowered.
Authorizing Tradition: Vectors of Contention in Highland Maya Midwifery.
Social Science & Medicine, 2004
In Guatemala, midwives deliver the majority of children and play an important health care role in rural areas. Maya midwives, using time-proven methods, are the chief providers of care for mothers and infants in these areas. In recent decades, however, the medical establishment has become interested in Maya midwives, and is currently engaged in training and certifying many of them. This study examines how Guatemalan health authorities have sought to change Maya midwifery, refashioning its vocational framework and retooling it in accordance with Western medical principles. I focus on the place of obligatory formal training and the use of biomedical materials in the experience of Kaqchikel Maya midwives, and consider how the health officials employ these means to undermine the midwives’ knowledge base. Encounters between midwives and formal health personnel reveal an ongoing privileging of biomedical knowledge, one that preserves asymmetrical relationships between these practitioners. This creates an environment favorable to health personnel, and helps them to extend their influence through the midwives into the community. Given this, I contend that health personnel value local Maya midwives primarily for their role in furthering the goals of biomedicine. 2003 Elsevier Ltd. All rights reserved. Keywords: Guatemala; Maya midwifery; Biomedical change; Maternal health; Child care
The changing role of indigenous lay midwives in Guatemala: New frameworks for analysis
Objectives: to examine the present-day knowledge formation and practice of indigenous Kaqchikel-speaking midwives, with special attention to their interactions with the Guatemalan medical community, training models, and allopathic knowledge in general. Design/participants: a qualitative study consisting of participant-observation in lay midwife training programs; in-depth interviews with 44 practicing indigenous midwives; and three focus groups with midwives of a local non-governmental organization. Setting: Kaqchikel Maya-speaking communities in the Guatemalan highlands. Findings: the cumulative undermining effects of marginalization, cultural and linguistic barriers, and poorly designed training programs contribute to the failure of lay midwife-focused initiatives in Guatemala to improve maternal-child health outcomes. Furthermore, in contrast to prevailing assumptions, Kaqchikel Maya midwives integrate allopathic obstetrical knowledge into their practice at a high level. Conclusions and implications: as indigenous midwives in Guatemala will continue to provide a large fraction of the obstetrical services among rural populations for many years to come, maternal-child policy initiatives must take into account that: (1) Guatemalan midwife training programs can be significantly improved when instruction occurs in local languages, such as Kaqchikel, and (2) indigenous midwives' increasing allopathic repertoire may serve as a productive ground for synergistic collaborations between lay midwives and the allopathic medical community.
The Changing Roles of Indigenous lay midwives in Guatemala: New frameworks for analysis
2013
Objectives: to examine the present-day knowledge formation and practice of indigenous Kaqchikel-speaking midwives, with special attention to their interactions with the Guatemalan medical community, training models, and allopathic knowledge in general. Design/participants: a qualitative study consisting of participant-observation in lay midwife training programs; in-depth interviews with 44 practicing indigenous midwives; and three focus groups with midwives of a local non-governmental organization. Setting: Kaqchikel Maya-speaking communities in the Guatemalan highlands. Findings: the cumulative undermining effects of marginalization, cultural and linguistic barriers, and poorly designed training programs contribute to the failure of lay midwife-focused initiatives in Guatemala to improve maternal-child health outcomes. Furthermore, in contrast to prevailing assumptions, Kaqchikel Maya midwives integrate allopathic obstetrical knowledge into their practice at a high level. Conclusions and implications: as indigenous midwives in Guatemala will continue to provide a large fraction of the obstetrical services among rural populations for many years to come, maternal-child policy initiatives must take into account that: (1) Guatemalan midwife training programs can be significantly improved when instruction occurs in local languages, such as Kaqchikel, and (2) indigenous midwives' increasing allopathic repertoire may serve as a productive ground for synergistic collaborations between lay midwives and the allopathic medical community.
Oaxaca direr considerably from those of biomedicine. Government training courses for traditional midwives disregard these deep-seated direrences, andalso the underlying conceptual rationale of ethno-obstetrics. These courses constantly reinforce and actively promote the biomedical model of care. But rural midwives, despite these training courses, do not substantially change their obstetrical vision and ways. The strength of their own authoritative knowledge, filly shared by the women and men of their communities, allows them to continue their traditional style of care, despite pressures to conform to biomedical values, belief, and practices. Suggestions for a mutual accommodation of bwmedical and midwifery approaches to prenatal care include training medical personnel in ethno-obstetric techniques and rationales. teaching midwives basic medical interventions, addressing in intervention programs all social actors participating in reproductive decision making, and adopting an interdisciplinary approach that includes nonmedical aspects of maternal care. [authoritative knowledge, ethno-obstetrics, traditional midwives, prenatal care, maternal health, Mexico] n the state of Oaxaca, as in many other Mesoamerican regions, traditional and empirical parteras (midwives) continue to attend the great majority of births I (Buekens et al. 1990:680; Cosminsky 1986:79; Population Information 198035; Zolla 1983:25-26), especially those that occur in peasant and indigenous Medical Anthropology Quarterly lO(2): 12 1-140. Copyright 0 19% American Anthropological As= ciation.
Maya/Guatemala Comadronas or Traditional Medicine Annotated Bibliography 1 7/6/23
The Project utilized three participatory approaches in tandem: the Census-Based, Impact-Oriented (CBIO) Approach, the Care Group Approach, and the Community Birthing Center Approach. Together, these are referred to as the Expanded CBIO Approach (or CBIO+). Objective: This is the first article of a supplement that assesses the effectiveness of the Project's community-based service delivery platform that was integrated into the Guatemalan government's rural health care system and its special program for mothers and children called PEC (Programa de Extensión de Cobertura, or Extension of Coverage Program). Methods: We review and summarize the CBIO+ Approach and its development. We also describe the Project Area, the structure and implementation of the Project, and its context. Results: The CBIO+ Approach is the product of four decades of field work. The Project reached a population of 98,000 people, covering the entire municipalities of San Sebastián Coatán, Santa Eulalia, and San Miguel Acatán. After mapping all households in each community and registering all household members, the Project established 184 Care Groups, which were composed of 5-12 Care Group Volunteers who were each responsible for 10-15 households. Paid Care Group Promoters provided training in behavior change communication every two weeks to the Care Groups. Care Group Volunteers in turn passed this communication to the mothers in their assigned households and also reported back to the Care Group Promoters information about any births or deaths that they learned of during the previous two weeks as a result of their regular contact with their neighbors. At the outset of the Project, there was one Birthing Center in the Project Area, serving a small group of communities nearby. Two additional Birthing Centers began functioning as the Project was operating. The Birthing Centers encouraged the participation of traditional midwives (called comadronas) in the Project Area. Conclusion: This article serves as an introduction to an assessment of the CBIO+ communitybased, participatory approach as it was implemented by Curamericas/Guatemala in the Western Highlands of the Department of Huehuetenango, Guatemala. This article is the first of a series of articles in a supplement entitled Reducing Inequities in Maternal and Child Health in Rural Guatemala through the CBIO+ Approach of Curamericas.
Reproducing Childbirth: Negotiated Maternal Health Practices in Rural Yucatan
2017
OF DISSERTATION REPRODUCING CHILDBIRTH: NEGOTIATED MATERNAL HEALTH PRACTICES IN RURAL YUCATAN This ethnographically informed dissertation focuses on the ways rural Yucatec Maya women, midwives and state health care workers participate in the production of childbirth and maternal health care practices. It further addresses how state health programs influence the relationships and interactions between these groups. Although childbirth practices in Yucatan have always been characterized by contestation, negotiation and change, their intensity and speed have significantly increased over the last decade. Drastic changes in the maternal health of rural indigenous communities in Mexico and throughout the world are directly connected to intensified state interventions that favor biomedicine over traditional health systems. In rural Yucatan, state health programs such as Oportunidades and Seguro Popular support a biomedical approach to birth by distributing medical resources to government cl...