From Charity to Solidarity

I think I came out of the womb wanting to change the world, to have impact for the better.  It’s innate to my being, and the circumstances of my childhood only strengthened that part of me that wanted to see things be better for people on Earth.  

I remember seeing a TV ad when I was a kid that showed Goldie Hawn (I think it was her) with some black babies and she was telling people they could donate $2 a month or something to feed one starving child in Africa.  I understood the intention but it never sat right with me.  Even as a kid I was wondering “Why are they starving in the first place?”

I understand a lot more now in terms of systemic global issues but of course the world is still a mystery for the most part.  What I do understand is that while charity has its place, the issues that face humanity are deeply complex and intertwined and require solutions that take everything and everyone into account.  What is required in my view is something much more radical than feeding starving children.  We need to address the roots of the issues. I also understand that while there are immense disparities and suffering in this world, along with immense wonder and beauty, we are not really divided into “haves” and “have-nots.”  In my view, we are all in this mess and in the beauty together.  Some of us have a lot more leverage and more comfort and privilege than others and have more impact (for better or worse) or can pretend to distance ourselves if we choose but no one is immune to the suffering of the planet and of humanity.  And every one of us can tap into the beauty and wonder wherever we are.  And though we might have a comfortable life or we might find ourselves in dire circumstances none of us is really separate from the world at large, though we may be blind to our relationship to it.

With this insight I have wanted to find a path toward making a difference that is not about charity but is based in an acknowledgment of our interdependence with all of life.  As a fellow midwife who has done extensive international work once said to me:  "All positive change happens through relationship."

I am happy to report that I have been finding that path in my experience at ACAM and the relationships and collaborations being cultivated there.

ACAM, CONCEPCION CHIQUIRICHAPA

I came here briefly in 2004, to this hidden mountain town of Concepcion Chiriquirichapa, to meet and interview midwives for a research project I wanted to do about midwifery and herbal medicine in Guatemala.  That project turned into a book called Voices of Maya Midwives (Lulu press, 2005.) In the process I gained a deep awe and respect for the women I interviewed.  I had a dream at that time of coming back here to work side by side with them to learn and share as fellow midwives.  The birth center was under construction at that time.

Fast-forward to 2015 and here I am living that dream.  When I reflect on the meaning of being here, it’s so much deeper than a cool exotic opportunity.  It’s about leadership, empowerment of women, vision for a better world, solidarity and sisterhood--and creating bridges across cultural, linguistic, national, and economic divides.  It’s about honoring the interdependence of all beings and finding my way back to a sense of wholeness.  

L to R: Azucena, Antonina, and Imelda at midwives meeting

Essence and I have spent two months with these women in their environments and have grown a deep love, appreciation, and admiration for all that they manage to do and quite simply for who they are in the face of a serious history of oppression and ongoing assaults to their way of life.  We marvel every day at the ways we see their strength, wisdom, and inner power manifested in the ways they work and live.

Two women, Antonina, and Azucena, have been the driving force behind this impressive  maternal health and cultural renewal project.  A couple of weeks ago I organized a field trip that helped me to see these two women and Antonina’s daughter, Imelda, in a whole new light and only deepened my appreciation of each of them.

BUILDING BRIDGES

The following are excerpts from my “report from the field for my colleagues at the BIrth Institute:

Essence and I went this week with Antonina, Azucena, and Imelda (with Andres, Antonina’s husband, driving) on a two day field trip.  We went first to Huehuetenango to visit Casa Materna, which is a maternity waiting home next to the only hospital in the department.  Wow.  There are people in that area that are up to 13 hours from any hospital.

We saw where they keep the women who have high risk pregnancies or simply live very far from the hospital in the special maternity home for 5 or more days on average.  They do not give birth there but they go to the hospital when they are 4 centimeters.  They have nurses and doctors on staff at the waiting home but no midwives.  We thought we would go to the hospital and see some births since they normally do about 50 deliveries a day there.  But for some reason there were no births that day.  

The midwives were told by the Casa Materna Staff that they should just say they are visitors at the hospital (I did have permission from the higher-ups to enter the hospital before we even traveled there) because if the doctors there knew they are midwives they would not let them in the door.  We as foreigners would not have that issue.  So, they did go in with us and as far I as I understand it was the first time any of them had the opportunity to be inside a hospital. 

The nurse in the delivery room (who didn’t have much to do since there were no patients) kind of gave us a tour and then started asking the midwives questions.  The midwives ignored the warning about concealing their identity since we were already there. 

Antonina explained to the nurse that they have a birth center near Xela.

ACAM Midwifery Center

“And who owns it?”  she asked.

“We do,”  Antonina said with her chin a little higher.

“And what if you need an I.V.?”

“We do it.” (note from me: True.  I've seen it twice.)

“And sutures?”

“We do that too.”  (note from me:  While it's true that they have the capacity to do sutures, they have their own effective way of dealing with tears, which has to do with tightly wrapping the women's hips in a "faja" after birth and doing a special vaginal steam bath in the temascal.  That's a whole other subject.)

And the conversation went on with the nurse about how the place is run and what they do.

I loved watching the midwives talk about themselves and their work.  They sure do hold their heads high.  It is clear from this and the other experiences we had that they are damn proud that the birth center belongs to them and that they are the ones who decide who works here and how decisions are made and what the care protocols are.  

The next day we were taken by the folks from PCI, the organization that runs the waiting home, to visit a group of midwives in Todos Santos, a totally quaint little town way high up in the mountains.  Pretty remote.  We were invited to go and the agenda was pretty loose.  I honestly wasn’t even totally clear what my intentions were except that it seemed like a good idea and the midwives were into it.

Midwives of Todos Santos, Essence and me in the middle.

The town has 150 midwives that receive trainings from PCI—most of them the same old boring trainings most midwives have been getting forever—about danger signs.  No one ever actually teaches them skills or hands out meds.  They just drill into them when to bring a woman to the hospital.  Pretty impractical if you have a massive hemorrhage or a woman in preeclamptic convulsions and the hospital is 4 hours away after you track down a vehicle.  Apparently they have done some trainings with doulas from the U.S. as well that were more engaging.

Antonina speaking to one of the Todos Santos midwives

So when we arrived about 30 midwives showed up.  We did some brief introductions as we sat in a huge circle and as soon as I mentioned plant medicine someone interrupted me and wanted to know what plants I used for labor.  It was a bit awkward as I wasn’t prepared to just start talking about specifics but that was what they all seemed to want.  We ended up going around and each of us sharing some of our favorite plants to use.  I used examples of herbs I have used for my kids.  When Azucena and Antonina started talking the questions started firing and they kind of became the center stage.  Azucena talked about her vision of reclaiming the medicinal knowledge of the ancestors and how it would be good for them all to get together again and to bring live plants so they would know specifically what they are talking about.  At one point I turned my head and saw that half the room was suddenly empty.  Where did everyone go?  I asked Essence.  Then I heard someone say they went to look for plants.  We found them outside gathering plants from the roadside to show the others what they were talking about.  They suddenly became so animated and energized! 

Imelda, Antonina's daughter, speaking to the midwives

They made plans for a group of midwives to travel from Todos Santos to the birth center in April to see with their own eyes what is happening here.  They are especially interested in the plant medicines.  Antonina, Azucena, and Imelda are all deeply interested in empowering midwives from other areas to reclaim their value and their place in the community and to build bridges with each other.  Antonina talked to them about how important it is for them to leave their communities sometimes so they can see what is happening in other places and spend time connecting with other midwives and learn and grow and become stronger this way.

These ladies are so inspirational and command such a presence no matter who they are talking to.  Essence and I have both grown deeply fond of them and are so inspired, impressed and humbled by who they are and how they show up for life.

Azucena speaking passionately about plant medicines

The beautiful thing about all of this is that connections were made during our visit and at the end of our lunch conversation Antonina said, “The time has come for us to have a national meeting of midwives and it needs to be right here at ACAM.”  The woman in charge of the waiting home had said something along the lines of her program being the number one model maternity program in Guatemala.  Over our lunch (not to the woman’s face) Antonina said, “No, it isn’t.  As far as I’m concerned, ACAM is number one.  We are the example.  No one owns us.  No one tells us what to do.  What those midwives need is their own maternity house in their own community like we have here.”

Judy Luce and ACAM midwives at the first meeting in 1999

I tend to agree.  ACAM is a model worth studying and replicating.  It has its roots in the community and will stay in the community.  ACAM was born out of a real need and the birth center was born out of a vision held by Antonina and Azucena.  They gathered the midwives of their community to begin addressing their common issues and through a fortuitous meeting with American midwife Judy Luce they were able to secure financial, technical and moral support for building a birth center.  They are incredible leaders and visionaries and are making a huge difference in their community and in my humble opinion this project deserves a global stage.  A birth center like this in every community in the world would for sure make the world a friendlier and more welcoming place for humans.

Essence, me, and Todos Santos midwives

I am convinced, now more than ever, that building bridges and friendships and creating collaboration between groups is essential for forward movement in social change.  During my short visit I have facilitated connections between ACAM and AMA (another birth center), with PCI and the midwives of Todos Santos, and with the Birth Institute and I see how much it strengthens and inspires the midwives to see this network building.  And they have their own networks as well.   As Antonina said to me today, “This is a collaboration.  We are doing this in solidarity with people from the U.S.  It's through this collaboration that we have learned to value ourselves and who we are and what we do. You have been an immense help to us in the births and in helping us make connections.  Without people like you who come here and others who support us this place would not exist.  And without the us, the midwives this place would not exist.  We are doing this together.” 

If you want to learn more about ACAM and their story, check out the very beautiful and moving video on their website: http://www.mayamidwifery.org/blog/

Cultural Humility at the Nexus Between Life and Death

“GRAB AN ONION!”  This is what the midwife said when baby Jose was born with the cord wrapped 3 times tight around his neck and he came out floppy and not breathing.  By this time Essence and I were familiar with the onion routine.  This was our third experience.  Mom or baby having a breathing issue?  Wave an onion in front of their nose and they perk right up.  Well, theoretically.

The first time we became acquainted with the onion was a few days after we arrived.  

“Sarah!  Come quick!”  Of course I thought it was a birth.  It wasn’t.  It was a woman who had given birth several hours earlier and had been having convulsions at home.  Instead of bringing her to the hospital they brought her to us. (Great.  Thanks.)  She wasn’t speaking, her skin was cold and doughy, and I couldn’t find a pulse or hear a blood pressure but she was breathing.  Barely.  While we were busy taking her vitals and assessing the situation she went into convulsions in front of us.  She seemed to stop breathing for a moment and her eyes rolled further back into her head.  That’s when the onion appeared.  Someone (one of her relatives) waved an onion under her nose and for a moment she opened her eyes and her consciousness came back in the room.  It was enough to get her breathing again.  At that point Essence and I were both impressed with the onion.  But clearly she needed much more.  Somewhere in that scene we called an ambulance and soon the woman was escorted to the hospital.

The next time we saw the onion we had a baby that was born at 4 1/2 pounds, prolapsed cord (cord coming before the baby--life threatening), limp and not breathing at birth.  I went full swing into neonatal resuscitation the way I have been taught, which involves giving the baby breaths.  When I came up for air, there was.... the onion, being held under the baby’s nose.  My instinct was to bat the onion out of my way so I could get back to work saving the baby’s life.  When I tried that, the midwife came right back with the onion.  She wasn’t about to accept my rejection of her favorite revival technique.  We settled into a rhythm (with a fair amount of reluctance on my part) of taking turns with me giving breaths and her waving the onion in between. I didn’t want to incriminate myself as some kind of arrogant midwife that rejects traditional ways and yet of course I wanted to save the baby and was sure that my way was his best chance.  After a good long time of our little routine he finally came around to breathing on his own, though with a fair amount of difficulty.  He continued to be limp, was super tiny and did not at all look like a happy camper.  I really really really wanted him to go to the hospital.  I was pretty sure if he didn’t go soon he could perish.

I talked with the midwife about it and she talked with the family in Mam.  Nothing seemed to be happening.  I said something again and the midwife simply said, “No quieren.”  They don’t want to.  That seemed to be that.  End of discussion. 

“Uhhhh, what?  What do you mean they don’t want to?  The baby is not well.  He’s limp, he’s hardly breathing.  He could die.  He needs to be in the hospital.”  

“No quieren.”  

It was a predicament.  The woman herself was not so good with Spanish.  I talked with her husband.  I talked with the mother-in-law.  They listened and then did nothing.  The husband told me a story about some other baby that was born not breathing and he is fine now.  “No.  You don’t understand.  This baby is limp.  He is struggling.  He could die if you take him home.”  No response.  I tried numerous times, talking with the family, talking with the midwife.  My pleas were clearly going nowhere.

This has never happened to me.  I am not used to people not taking my advice as a midwife.  If I say we need to go to the hospital, they go.  I do not take the decision lightly.  I hate sending people to the hospital but I do it when I have to and have never had someone just ignore me like that.

I talked with the midwife in private about it.  “Why won’t they go?”  I asked.  

“This is just how people are,” she said.  “They don’t want to go.”

“Is it because of money?” I asked.  

“Most likely,” she said.  It costs a lot of money and the government doesn’t pay for it.  People prefer to take the baby home and if it lives, it lives, and if not, then it’s God’s will.”

I cried.  I let go.  

“Don’t be sad,” she said.  “This is just how it is.”

I switched my tactics from trying to get them to the hospital to giving them instructions for caring for the baby at home.  I taught them about dropper feeding (I gave them one of my empty dropper bottles and showed them how to do it) because the baby didn’t even have enough life force to nurse, and I taught them about kangaroo care.  We got mom and baby naked together and I had the midwife explain everything about skin to skin contact.  I have no way of knowing if they followed my advice after they went home.  Before we knew it, they were packing up to go home and I clearly had nothing to say about it that they cared to hear.  I would have preferred they spend the night and said so but that was also falling on deaf ears.

I asked them to come back in two days and explained to them why I wanted to check on both baby on mom.  I asked the midwife to explain in Mam.  I told them there would be a doctor here that day (which was true) and they agreed to come back.  They never came.  We did not hear again from the family though they have the phone number of the birth center and could call if they need us.  I don’t know what happened to the baby.  I wish I did.  I think about the experience a lot.

In my mind, I am present at births for many reasons, one of them being to save lives and to let people know what needs to happen in order for lives to be saved.  This experience poked a huge hole in that assumption.  Who am I to tell a family that my priorities of saving their baby’s life in the ways that I know how are more important than theirs, whatever they are?  I can’t know all the reasons why it was so obvious (there seemed to be no discussion amongst them) that they would not go to the hospital no matter how much I insisted, explained, warned, etc.  Nor can I know why they did not come back.

What I do know is that I learned something about cultural humility.  It’s not ultimately my choice.  I am simply a servant and a witness.  I have expertise but I cannot insist that others receive my offering.  They will do what they want to anyway.  Is it right?  Wrong?  Should I, could I have done something else?  I don’t know.  I don’t want to throw my hands up and say “it’s not my problem” and neither do I want to push my agenda on someone else.  But when someone’s life is on the line...and that little being cannot speak for himself....what to do?  It’s a big question.  And the humility is acknowledging that I don’t have the answer.

As for the baby I mentioned above, with the cord around the neck, it was a breeze in comparison to these other experiences.  With the onion, and some vigorous stimulation, he came around to breathing and was totally fine after that.  These ladies swear by their onion.  I, on the other hand, am simply remaining open to what I don’t know and what I don’t know I don’t know.

Wisdom of the Midwives

There was a knock on our apartment door....“Hay consulta!”  (There’s consult here!) one of the midwives said.  Essence (my student) and I were called into the prenatal room, as we normally are when a woman comes in for a prenatal check-up.  

Maria (not her real name) was in her last month of pregnancy.  Santos, the midwife on duty had already been checking the baby and when we came in the room, she asked Essence to go ahead and check.  Essence checked the position and then looked for the heartbeat but could not find it.  The baby was clearly moving so there had to be a heartbeat somewhere.  I stepped in to find the heartbeat and also could not find it.  I searched and searched while Santos stood by watching, patiently.  She waited for me to give up and then said,  “Donde esta la cabeza?”  (Where is the head?)  Only then, I checked for the baby’s position (duh) and the head was near the woman’s ribs.  The baby was clearly breech.  She must have found me humorous. “Allow me,” Santos suggested.  I stepped out of the way and she started her work.  She lathered up the woman’s belly with lubricant and explained what she was about to do--move the baby to a head-down position, which is much more conducive to a safe birth.  

She lubed up the woman’s belly with an herbal salve (Azucena makes all the herbal preparations) and began talking to the baby in Mam.  She translated for us, saying, “I’m telling the baby that the the doorway is not here, it’s over here, and he’s not going to be able to get out over there.  He has to move down here so he can get out.  I am explaining to him that he needs to move.”  All the while she massaged, and shook and jiggled the baby, with one hand on the baby’s head and the other on his bum, with sweeping massage motions in between.  She talked the baby through the whole thing and the woman lay completely relaxed.  For my own comfort I checked the heart rate before and after the procedure and the baby seemed to tolerate it quite well.

Within a few minutes she had a head-down baby, whom she instructed to stay there.  Maria was asked to come back in a week to make sure the baby stayed and that was that.  What we witnessed is something that Maya midwives have become known for, first through the work of Bridgette Jordan, who wrote about Maya midwives in Mexico in her book, Birth in Four Cultures, and then through the work of anthropologist Robbie Davis-Floyd, who has written articles and given many lectures, also about Maya midwifery in Mexico.  Here, they call it “componer el bebe,” or getting the baby in the right position.  In western obstetrics it has a fancy name--External Cephalic Version.  If it sounds intimidating, it’s with good reason.  In the U.S. it’s normally done under ultrasound and often with relaxant drugs and a lot of warnings about possibly needing to go into surgery if it doesn’t work or anything bad happens.  And only some obstetricians will do it.  Most will simply order a c-section for breech.  Some midwives in the U.S. do it but it is frowned upon, in my experience, because of all the fear and liability in the obstetrical world.  

Here in Guatemala, it is common to see a lot of babies that are lying sideways or in breech position.  I have my own theory about it that it has to do with the way the women wear their skirts, with a belt around the top that sometimes doesn’t leave a lot of room for the baby to get into the best position.  Whether or not my theory is accurate, when there is a midwife who knows how to get the baby back where it belongs with so little fuss, it becomes a non-issue.

In another prenatal visit, Essence and I had done our usual listening, measuring, and connecting with the mom and baby and as I was helping the woman sit up, it was clear she was in some pain.  Then Antonina, the midwife, said, “Hold on... i have to do her massage.  You don’t do this, do you?”  “No, “ I said, “go ahead.”   She put her hands on the woman’s big round belly and began to knead, and massage, and jiggle, and push and pull, all so gently and kindly.  “Suave,” she said.  Gently.  Chaba (In Mam)  In Mexico, they call it “sobada.”  Here they call it “masaje,” which just means massage.  She spent about 5 minutes on this massage, and as she did she explained, “This is one reason why the women like to come to the midwives.  The doctors don’t do this.  Often the woman will have a lot of aches and pains and when the midwife does her massage, she feels better.  That’s why they ask for it.”

Another thing we have have seen is the binding of the uterus after the birth.  Azucena took a wide belt and wrapped it tightly the morning after the birth around the woman’s hips.  She wrapped several times around and pulled hard and tight, like she was cinching it.  She explained that she was pulling tight to squeeze the hips because that in turn squeezes the uterus and helps the woman so she will not bleed so much after birth.  This is done for all women here with the idea that it aids in overall postpartum recovery.  I learned from Essence today that her great-grandmother, a granny midwife from southern Florida, did the same thing with her ladies, only she used a strip of an old sheet instead of a handwoven belt.  And that tradition was passed down to her daughters and granddaughters.

For me, there is much to be learned from working alongside these midwives.  And it’s not even so much about “technique.”  Techniques can easily be learned and transferred to other settings. It has more to do with their way of being.  Santos, for example, exudes a quiet confidence that puts women at ease and makes it easy to just follow her and do what she says.  I watched her in a life-threatening situation stay cool as a cucumber and do what was necessary to get the woman to the hospital.  I was totally shaken up after the event and it was her groundedness that helped me get back to equilibrium.  

And Antonina, for example, spends most of her time in the prenatal visits asking questions, telling stories, and making the women laugh.  I do way more laughing than midwifery skills in my visits with her. Unless you want to count humor among those skills. It’s about the way in which the midwives are so much like their clients, and that creates a certain integrity and continuity with the women they serve.  An ease and comfort and familiarity.  They dress the same, speak the same local language, struggle with the same issues of poverty, ethnic discrimination, and male chauvinism.  Antonina joked with one woman who’s husband had gotten her pregnant and then left as a wetback (or “mojado” as they are referred to here) for the states, “Well, at least you won’t have to deal with him for another 10 years.”  They all found that extremely funny.  

And then there’s Azucena (Lily)--keeper of the herbal wisdom.  The herb garden is her baby here at the clinic.  She gave us a tour and named every single plant and how it is used.  She even knows some of them in English because she has given talks to groups of American students and has learned them that way.  Various medicinal herbs are usually found drying in the special greenhouse on the roof of the birth center and huge bags of dried herbs are found in glass cabinets in the waiting room, along with special mixtures for urinary tract infections and other common issues in childbearing.  All of the midwives know how to use the plants but Azucena leads the way in these matters.

These midwives know how to keep a woman healthy with food, herbs, massage, loving and competent care, and good advice-- the things that are most accessible, and they know how to attend a birth in a way that makes sense to the woman and her family and makes the woman feel well-cared for on all levels--physical, emotional, intellectual, and spiritual.  These are the wise-women of the community.  It’s really clear.

When the midwives are in the clinic and not attending to women, they are cooking, cleaning the birth center, attending to the herb garden or working on weaving and handwork projects.  They may also be involved in meetings on any given day of the week.  There seem to be an endless stream of meetings.  Meetings with each other, meetings with other women’s groups, meetings with representatives from various groups to address issues of women’s rights, poverty, education, environmental contamination, and the encroachment of transnational enterprise.  I find myself deeply impressed with both the day to day talents I witness and the commitment to a larger vision of collaboration for change in this country.  I have much to learn here.

What on Earth is going on with the children?

Alma was laboring quietly and in her own world as we sat with her, waiting for the labor to do its work.  Ofelia, the midwife on duty, was very chatty that evening and began telling me about her son in the U.S.  “He’s 25 and he’s going to school and working in construction, “ she said.   I gathered she was proud of him.  The story was that he went to the U.S. when he was 16 years old.  A friend basically said to him, “let’s go.”  Ofelia was scared for his safety and did not want him to go.  The journey north, including crossing the Mexican and U.S. borders illegally, is a dangerous one.  Especially for someone 16 years old.  “And he made it,” I said.  “Yes, he did.  Gracias a Dios.  (Thank God.) A lot of them don’t make it.”

Last summer, when I was preparing to return to Guatemala I received several unsolicited warnings (by concerned people who care about me) about the worsening situation here, as exemplified by the news coverage of a growing crisis in the U.S. around child migration.  Thousands of unaccompanied minors are currently crossing the the U.S. boarder illegally every week from the northern triangle countries of Honduras, El Salvador, and Guatemala. 

 http://www.vox.com/2014/6/30/5842054/violence-in-central-america-and-the-child-refugee-crisis

A couple of weeks ago I was talking with my mother and told her that I had organized a visit to the Guatemala Human Rights Commission to get a briefing on the human rights situation here for women.  My mom was born and spent her childhood in El Salvador and has always maintained certain ties to Central America.  I am grateful that she asked me to do her a favor, which was to ask about what is happening on this end of the child migration crisis.  Why were so many children leaving?  She said the news media was not covering the story adequately and she and many people in her Quaker meeting in Minnesota were deeply concerned about the conditions of the detention centers (prisons) where the children were being held.  They wanted to understand what was going on and figure out a way to help.  

“What specifically do you want to know,?” I asked.  

“Anything,” she said.

I decided to take it on and see what I could find out.  I went to the human rights commission (ghrc-usa.org) with two other women and we sat and listened for 2 hours to a woman with over three decades of experience working in the human rights field in Guatemala.  I was not surprised when she told me she was planning on writing a book.  She was a gold mine of insight and information.

I asked her many things (mostly about women) and one of them was about the Guatemala side of the child migration story.  She didn’t miss a beat.   What I understand from all she told us is this:

There are three big factors effecting shifts in migration.  One is that there has been a cycle starting in the 70’s of migration that started with men going north, then their wives, and the children staying in Guatemala to be raised by the grandparents, with the parents going back and forth.  When the children get old enough they migrate for work, their parents stay behind to raise the next generation of children and the cycle continues.  This has been going on for the last 40 years.  But things shifted when the policy of deportation became more strict in the U.S. and many of these people were getting deported and the underground migration systems they had come to rely on no longer held.

The story of the migration cycle was confirmed by Antonina, the leader and visionary behind the ACAM birth center project, where I am currently working.  Somehow, without my even asking her, she launched into a lament about how so many people are going to the U.S. to make money.  And the “pobre abuelitas” (poor grandmas) are left behind to take care of their children by themselves.  She said that sometimes, if they are focused, they can make money and bring it back to their families.  But so many of them get lost, “perdidos,” in the vices of drugs and alcohol and they forget why they are there.  She said it is contributing a lot to the disintegration of family.

The second factor affecting shifts in migration is that between 2004-2007 there were a whole series of entire communities that were displaced to make room for large plantations of teak, sugar, and palm oil trees.  This created a desperate situation for these families.  She estimated about 424 communities, around 22,000 families were forcibly removed from their land.  This is a direct result of the Central American Free Trade Agreement (CAFTA) that allows companies to do this kind of thing, legally.  

And the third is about the business of human trafficking, which has become big business.  Families pay $8-10,000 US to “coyotes” who will bring their children north.  I was talking with one of the midwives at the other birth center where we were for a couple of weeks and she confirmed that this is indeed a huge issue in Guatemala.  “Where do people get that kind of money?” I asked.  She said sometimes they borrow it, or sometimes they will sell their land.  There is a certain desperation.  Families are sold on the idea that the children will be cared for and will have better opportunities to make money in the U.S.  Families also believe that the children are being protected by U.S. minor laws because the U.S. is not allowed to deport minors by themselves.  This, for now, is true.  What the families do not understand is that the children are being held in detention centers under horrible conditions.  All they know is that the children do not come back and parents are convinced that they have been successful in their migration.  Because of this, they keep sending more children with these coyotes, who are the agents of the human trafficking business.  Of course along the journey through Mexico, many children do not make it.  They get raped, robbed by extortion, or killed or they get kidnapped for drug trafficking or sex trafficking if they are the right sex and age.

The woman we spoke with explained that since 2008 there has been a steady increase in child migration to the U.S. and that in 2011 some of the children started to be deported by Mexico, only to return to the same dire conditions which they left, after their families had spent thousands in the coyote’s fees.  The number of children migrating rose in 2013 and the the U.S. was no longer capable of sustaining the phenomena and began to threaten to deport the children alone.  Currently, there is an active involvement of the U.S. state department to create safe houses for children in Guatemala and Honduras so deportation of minors can start.  

She explained that people send their children because of a naive belief in magic solutions to their economic problems, which she attributes to a shift to individualism from communal values.  This she ties directly back to the huge rise in evangelism, which promotes fear and the disintegration of communal interdependence through the concepts of individual salvation or damnation.  And parents believe the children will migrate successfully, because of U.S. child protection laws whereas the adults have a high chance of being deported.  She said something really profound about this that I really appreciated.  She said that you cannot get out of poverty by yourself.  You need the support of social and systemic structures to change the conditions of poverty.  I think this applies just as much to the U.S.

So all of these factors combine to create something that is quite a giant mess of a human situation.  The U.S. bears responsibility in some of this for CAFTA, which makes it legal for profit-seeking foreign businesses to enter the country and displace communities from their homes at will, for our heavy-handed immigration and deportation policies, for our double-standard of deportation and using the same people as cheap labor to keep the economic machine running, and for the exportation of evangelism (not a government thing, obviously, but it comes from our country) which promotes individualism, fear, and mysogyny, which keeps women oppressed and without a voice and that in turn prevents human progress overall. 

In response to the question of what concerned citizens can do in the U.S.  she gave this response:

COMPREHENSIVE MIGRATION LAW AND PRESSURE TO THE GOVERNMENTS OF GUATEMALA, EL SALVADOR AND HONDURAS TO CHANGE AND DEVELOP INSTITUTIONS (TOO MUCH TO ASK?

To learn more, go to the GHRC website:

http://www.ghrc-usa.org/our-work/themes/child-migrants/

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.

Update on Midwife International:

Just a quick update. We now have a complete board of directors--9 outstanding women who are fully behind what we are doing. Also, this week our stellar team of two in Guatemala traveled to the city along with one of our future students to present our program. There were 17 officials present, ranging from high level ministry of health officials and their aids to representatives from the UNFPA, the Panamerican Health Organization, and the public University of Guatemala. The overall spirit of the meeting was extremely supportive of our project and more meetings are scheduled to discuss how to move forward! We seem to be getting a green light at every turn.

It is my conviction that if we can build truly collaborative relationships with all of these players--the ministry of health officials, officials from the international health bodies, officials within the education system, the student midwives, our staff and board, the existing community midwives, the families themselves, the medical staff in the hospitals and health posts, and a wide base of donor support--then we can create a maternity care system that puts the needs of women and babies at the center and finds the way to truly serve those needs. That will be a new day.

An ending and a beginning

"An idea whose time has come...

Cannot be stopped....

By anyone...

Plant your seeds...

In fertile ground

There ain't nothin'...

Gonna keep it down"

From "We Can Do It" by Pat Scanlon


I left Guatemala but Guatemala has not left me. The work I started there continues to unfold and the vision in my mind of young eager midwives and families who deeply value midwifery and home birth stays with me as a powerful motivating force.

It is with great excitement and pleasure that I am announcing the launch of Midwife International and Ixchel-Atitlan: Intercultural School of Midwifery. The school will serve both Guatemalan and international students and provide a comprehensive education that will prepare students for out-of-hospital birth practice and international work. Participating in the conception and gestation of this school (the birth has yet to come) has been a process of watching the divine in action and miracles unfolding.

I am convinced, now more than ever, that God needs our eyes and ears, and our voices, hands and feet to create the heaven on Earth so many of us wish to experience and some of us know is possible. We will know what this is when we join with others to make a fierce commitment to love. We cannot afford to wait for the winds to shift. It will require the gifts of every person who is at all awake to a higher consciousness. It is our willingness to make ourselves receptive and available and to respond to the needs at hand with the best of who we are and what we have to offer that is going to make or break our collective future.

Of this I am sure. I’m hardly an evolved soul but I can still do what is given to me to do as I learn to live more consciously.

Ixchel-Atitlan is a dream come true. Not my dream but a dream that has found its way into any receptive space it could find.

Our little team (four out of the seven of us) had a celebration feast just before I left Guatemala and I got to hear a story that was profoundly inspiring. Ester, the indigenous midwife at the root of this project, told us how this all began. In 1986, when she was a young woman and a new midwife, she had the opportunity to travel to the U.S. with her parents for a conference of some kind. While she was there, she met someone who asked her what her dream was. She thought about it and said, “I want to create a school for midwives.” The woman asked her to write it down and hold on to that dream. Fast forward 15 years and Ester again had an opportunity to travel to the U.S. At that point she had many years experience as a midwife. This time she went to a midwifery conference with the help of American midwife, Cindy Waterman. Again she met someone who asked her what her dream was. Again it was a school for midwives. Again she wrote it down. Fast forward nine more years to an auspicious and synchronistic moment in time. I showed up at the lake. At the same time, Mariu Gobbato, a young mother and aspiring midwife, moved to San Marcos and Corina Fitch, a midwife who grew up on the Farm, also showed up for a visit. Alicia DaCristaforo had been talking to Ester about the idea of the school and she managed to gather us all for a conversation. From that first meeting, the ball started rolling.

There have been many moments in this process that have been pivotal and miraculous but three stand out that I will mention. The first happened before the idea of a school was even much in my consciousness. I was talking to a friend of mine in San Marcos, Dr. Bill, (one of those rare physicians that really “gets it” about midwifery). He had just finished reading my book. I remember him saying, with a lot of intensity, “I want you to dream big. What would you do if you could do anything?”

That of course, is a good question for anyone.

For me, the wholesale loss of normal birth as a human experience on a global scale is a major tragedy. A heartbreak for humanity. Because the opportunity for re-membering the truth of our interdependence and the love we are made of through the experience of birth compares to nothing else. It’s an incredible gift that is being squandered. Drugged and surgical birth just aren't the same. For whatever reason saving birth has become part of my mission in life. My answer to his question was, “I would save midwifery here in Guatemala BEFORE its gets lost.” He just smiled and nodded his head. In that moment I was given permission to be totally audacious--in a good way.

The second moment (a series of moments) was several months later when I was riding the public boat to San Pedro, late for a meeting with some potential students and Ester. Stephanie Bonin happened to be on my right and she struck up a conversation with me about my project. On my left was her friend, visiting from Colorado for a week vacation. He overheard the conversation and told me I should meet his wife, also named Sarah. She was in the back of the boat and he introduced us when we disembarked. Several days later Sarah and I met at the clinic and Sarah did an interview with me for her blog, Mother’s Advocate. The link to the interview is below. As I explained to her the vision for our school, tears started streaming down her face. As it turns out, she had had a similar vision many years earlier of an international school for midwives. Her vision was to create a school where North American student midwives could get their education in a place where the need was great, alongside local women who would be serving their own communities. She had also recently been asking the universe for a way to use her talents and time in service to something bigger. She had found the answer to her seeking.

One thing led to another and Sarah Kraft has become our executive director, contributing tremendous amounts of time, skills, talents, vision, and commitment. I could not have invented a better executive director in my imagination. I am forever grateful to hand off that piece to someone who has skills in organizational development and fundraising. I want to focus my efforts on midwifery practice and mentoring midwifery students. I have a vision of mentoring midwifery students in a way that I craved during my training but never experienced. I think of it as “midwifing the midwife.”

So here is the really interesting piece....Sarah Kraft had a vision of somehow getting involved with midwifery in Guatemala (separate from the other vision I recounted) when she attended the midwives conference in New Mexico in 2001. That was the first conference that hosted traditional Guatemalan midwives, Antonina Sanchez and Berta Juarez, to teach a class on herbal medicine. It was because of them that I went to that conference and when I met them I knew I needed to go to Guatemala. I had a vision of being involved somehow in midwifery in Guatemala but I didn’t know what that looked like. Ester happened to be at that same conference though she was there only as a participant. That’s where she wrote down her dream for the second time. Ester still has those two slips of paper.

So how’s that for synchronicity? I continue to watch with rapt attention as the process unfolds.

The third moment, was shortly after I met Sarah, we were sitting at a gathering and she asked the people gathered to each tell about the biggest transformation we had experienced this year. I remember surprising myself by saying, “I have moved from trying to figure out how to make my own life work to wanting to make things work for a lot of people.” It is a very fulfilling and energizing place to be. I am still very much motivated by this drive.

Our website tells more: www.midwifeinternational.org

Here is the interview that Sarah Kraft did with me:

http://mothersadvocate.wordpress.com/2011/05/09/676/

Also, my slide show is up on youtube now. Much easier to watch and better resolution: http://youtu.be/fGROuZCq5-U

For those of you who are passionate about global birth change like me, you have got to check out this new social media project called One World Birth at

oneworldbirth.net

Your comments are appreciated!

Peace,

Sarah