Sunday, February 8, 2015

Guatemala: a land of extremes

Lila (not her real name), with her pale skin and long silky copper-colored hair, came to the birth center for her post-partum visit with her new baby.  The midwife was concerned she might not come because of feeling embarrassed about the events leading up to the birth.  Lila had not come to the birth center in Guatemala City to have her baby as planned but had ended up with a c-section instead.

Lila had been seeing the midwife throughout the pregnancy and looking forward to a natural birth for her first baby, something that is becoming almost unknown in Guatemala City.  Another woman in the birth class we (my student and I) attended that evening said she had told her obstetrician she wanted a natural birth and he told her “natural birth is obsolete.”  To her credit she looked for, and found, a midwife.  

This same midwife, Hannah (a German midwife, trained in the U.S. and working in Guatemala) sat and listened to Lila’s story.  Lila had been feeling the pressure from people around her about having “passed her due date” by a couple of days.  She and her partner decided to get an ultrasound to check on the baby just for reassurance.  Hannah asked them to check back with her after the ultrasound.  While Lila was having the ultrasound the doctor became alarmed because the baby’s heart rate was 118 beats per minute.  (Normal is considered 120-160 on average so 118 is hardly worthy of alarm in absence of other issues.)  After Lila changed position the heart rate went up to 128, which is well within normal by any standards.  The doctor said it was still too low and ordered a cesarean that same day.  And that’s how she ended up with surgery after planning the whole pregnancy for a natural birth.

She sat on the couch in the birth center and as she told this story she began to sob.  She never expected this to happen.   And she said she felt like she had been fooled--  “baboseada” was a new word I learned.  The sense of needless loss of her birth experience and grief was intense and palpable.  There she sat with the fresh raw wound across her abdomen, unable to go back in time.

This story may sound absurd if you know anything at all about birth, but what is even more absurd is the fact that in private hospitals in Guatemala City, 90% of births are done by c-section.  In public hospitals 50% or more are done by c-section.  When the surgery itself (vs. vaginal birth) carries 4 times the risk of maternal death, in a country that already has one of the highest maternal mortality rates in the western hemisphere, not to mention the risk of infection and other complications, including physical and emotional trauma to both mother and baby, and the immense loss of the birth experience that I can’t even begin to unpack here, these statistics are talking about extreme violence against women and a crisis in human rights for women and babies.  Hannah called it sick.  I call it criminal.  To be clear, I don’t think any individual doctor is a criminal, but in my view the system that breeds them  to behave this way is criminal in nature.

I have, for my own reasons, a deep interest in protecting the basic human rights and dignity of women who are pregnant and giving birth, and their babies, everywhere in the world.  For me, supporting the preservation and development of midwifery is a key strategy toward that end of protecting childbearing women and their babies from unnecessary harm and guarding the sacred space of childbirth.

Somehow this lifelong passion has led me over and over to Guatemala, a land of extremes and perplexities.

I took my concern about this extremely unnerving news about the c-section rates to the Guatemala Human Rights Commission where I spoke with a woman I will not name here, a human rights veteran who has been working in the field for 35 years.  She was aware of the situation for women and birth and knew that women are not given any option about their births.  They go to a doctor and the doctor, most of the time, tells them they are going to do a c-section.  They don’t even tell her why a lot of the time.  There is no dialogue and often not even excuses about saving the baby.  She said if you ask them they will tell you that the student doctors need to practice and that’s why they do so many.  She said that women need to know that they have a right to decide what happens with their own bodies.  Women don’t even know that.

The women that find Hannah’s clinic in Guatemala City do know that they have a choice.  They are small in numbers but powerful in their determination and willingness to go against the grain that is all around them.  That takes a lot of courage in my book and I see these women as birth revolutionaries in the making.

One woman in the birth class took a half an hour or more to tell the story of her natural birth at the clinic in the most dramatic and entertaining way possible.  I could see her taking a microphone to talk about the importance of birth and creating change in Guatemala.  She was on fire.  Then her husband took his time telling his part of the story.  It was really beautiful to see such passionate energy from them both and a mesmerized room of expectant couples.

I was left processing this experience for quite some time afterward and thinking about the implications of a society without vaginal birth.  Forget natural, not even vaginal birth.  In talking with another midwife about it and asking what will become of humans without birth, she said, “we will be a very different kind of human.”

In most of the rest of Guatemala, a stark contrast exists.  In most places here there are not enough doctors by any stretch of the imagination to serve the needs of the entire population, for birth or anything else.  Midwives work mostly in isolation in rural areas, without adequate tools, sanitation, training, or support from the larger system.  Communities face hard choices about life and death on a regular basis.  Women face unbelievable challenges in getting basic health care and as a result many do not get the most basic care.  Many women die and many babies die, not because of any fault of the  midwives, but because of a system that is failing them in every way.  

Today I learned from another american midwife who has been involved here in Guatemala for a while that she was speaking with the Guatemalan Minister of Health at one point and he said to her about the indigenous women, “it would be better if they all die.”  So that’s the leadership in health care here.

The situation here is quite shocking and intense.  And I ask myself, what am I here for?  What is being asked of me?  I don’t know.  I can’t say.  What I can say is that I am following a lead from within and I will see where it goes.  First and foremost is to remain present with eyes wide open.  And not to turn away in the face of suffering.  But to make room for it in my heart and see where I want to go from here.

At the moment, I am landed for the next couple of months with my student, who has come to me through the Birth Institute study abroad program, at a birth center in the Western Highlands, ACAM.  ACAM is a women’s health center that is designed, owned, run, and staffed by indigenous midwives from the Mam area.  The women here are taking charge of forging their own path forward, creating a new history for themselves, and putting themselves on the map.  They are improving women’s birth options and women’s health and creating something that no government of theirs would ever give them.  They are stepping into their power in a big way here.  They are truly inspiring.  So this is a good place to be.  I am more interested in inspiration and positive change than in telling a sad story, though both are important to me.

In the few days we have been here, we have seen first hand how this place fills a vital need for the community:  a place where families can go to receive quality care that's culturally safe and respectful, a clean and and comfortable place to give birth where the whole family is embraced and women can give birth in a way that makes sense to them and keeps them in integrity with themselves and their culture.

So being here and seeing what I can offer is my next step.  I hope to have stories to share from here on this blog as time goes on.


  1. Thank you Sarah for sharing this. I am glad to know more about what is going on. Thank you too for following your leading to be there. I know it is a journey that asks a lot of you on all levels. You are standing eye to eye with the way things are and continually putting your heart, actions and will into making things better. And you are finding allies who are doing the same and adding the weight of your being to what they are doing. That gives me hope and inspiration. I look forward to hearing more about your experiences, thoughts, insights. My encouragement, love and appreciation go with you.

  2. Sarah!! Leer tus historias me recuerda cuanto nos necesitamos las mujeres las unas a las otras, y lo importante que es darle visibilidad al valiente trabajo de las comadronas, y su sabiduría para traer vida a este planeta. Me siento muy contenta de ser tu amiga, tu hermana, de acompañarte en el camino de seguir a tu corazón. Si algún día tengo un bebe, voy ha actuar de una manera muy distinta ahora que me despierto a esta sabiduría a través de tu blog.Gracias por compartir tus experiencias, me cambian la mirada de la vida y la mujer.