This week, Mother’s Advocate speaks with Sarah Proechel, a Certified Professional Midwife working in Guatemala on Fulbright Scholarship. In this inspiring interview, Sarah discusses her perspective on hospital interventions in Guatemala, preservation of Mayan culture, and her own endeavor to open a midwifery school in the Guatemala highlands.
MA: There are a lot of women in the United States who become involved in the birthing community because they feel compelled in a in some larger way – as though supporting mothers through the birthing process is a part of their life purpose or destiny.
SP: For me that’s very true. I had things like this happen to me when I was very young but it was never confirmed. It was a big struggle for me to own that calling as an adult – until recently. If I had had somebody saying “oh yeah you’re supposed to be a midwife and that’s why you’re having all these dreams and these feelings”, I think it would have made a difference in my life.
Things are different here in Guatemala. Most women who become midwives are aware of their calling from a very young age. One of the typical stories you hear is that a woman was born “in the caul,” which means with the bag of waters intact at birth and that is sign of destiny, that she will be a midwife. She grows up with that story and that begins to live into it as life presents its opportunities. She may also or alternatively experience a series of dreams involving babies, pregnant women, dolls, or coins. There are many things associated with pregnancy and birth that show up in dreams that can point to a calling. She is therefore validated and called “comadrona” before she has any experience or training whatsoever. I find this so beautiful and life-affirming. A boy who is born in the caul is said to be a “curandero”, or healer.
There was a doctor in the room at the first birth I attended here, and he wanted to break the bag of water. I asked the mother if she wanted the bag broken and she said “no”. Eventually the doctor was asked to leave. That day, the baby was a boy and he was born in the bag – so it was meant to be. What if we had intervened? It would have literally changed the course of that boy’s life.
MA: You are working with a group of midwives and activists from Guatemala and the United States to open a midwifery school. Tell us about your vision for this school.
SP: Our vision is to have a training center/midwifery school that will serve the local women who are chosen as midwives — and also provide a unique educational opportunity for student midwives from the United States, Canada and beyond. The philosophy of the school is one of leadership and collaboration – this is not a top down model. It is the vision of Ester Pop Tuch who is a traditional midwife from San Pedro – a really competent midwife who has attended hundreds of births. Jumping off from Ester’s original vision many talented people have joined the project and it is becoming a truly visionary model that has the potential to really shift the discourse and the direction of midwifery in developing countries, beginning here in Guatemala, where home birth is still the norm.
The school curriculum will combine the midwifery model of care with Mayan healing traditions – herbal medicine, spiritual cleansings, spiritual guides and birth wisdom. We can really help this community by training the midwives in the midwifery model of care and emergency medicine so that the midwives know how to handle complications and when to transport to the hospital. They Mayans have a rich tradition of midwifery and home birth, which has been eroded away. There’s a long history of discrimination and abuse and colonialism and war; and midwives during the war were picked off because they were community leaders, so they were the targets. We want to scoop that tradition back up into a container where it can be passed on to future generations, ideally in a way that is healthier, stronger, and more sustainable than it has been.
MA: How will this project improve birth outcomes and lower intervention rates in Guatemala?
SP: I came here to research high maternal mortality rates in Guatemala. On the surface it looks like women are having their babies at home and that’s why they’re dying. There is a relationship there, but it’s much more complicated then it would appear on the surface. Here’s what I’ve seen:
People in this area, on the whole, prefer home birth. It’s culturally expected – anyone who comes to the clinic to visit me for a prenatal is expecting to have a baby at home. They don’t have any desire to go to the hospital and deal with the scene there or be operated on. You don’t see people who are like “oh just cut me open, that will be easier.” They really value home birth; they really value their midwives.
However, women are being told that they must visit the health post during their pregnancy – which is outside of the midwives sphere of influence. Theoretically that could be OK, except for the fact that the health centers uphold a medical model of care. Women who go to the health post – I’ve seen this over and over – are much more likely to be told, for one reason or another, that they need to go to the hospital for the birth. They reasons given are things U.S. midwives would balk at, like being over 40 weeks, being diagnosed with a “narrow pelvis,” or a baby that’s too big, being told that the baby won’t come out because the cervix is posterior or because the baby is posterior, to name a few. All of these things are utterly absurd and the sad part is that most of them do not seem to make it out of the hospital without a c-section.
When mothers end up at the hospital, they have to be alone – no partners, no midwives allowed. No support person. Absolutely none. That’s hospital policy across the board. This is problematic on many levels. There was this really fantastic study that was done my Nicole Berry, which correlates high death rates to a fear of going to the hospital (among other things) – women don’t want to go even if they know they need to go. They wait too long, so it’s a last-ditch effort going to the hospital, and then it’s too late. I have definitely seen this playing out but I have also seen almost the opposite. I have seen many women that are easily convinced that they should go to the hospital even though the reasons given to them are bogus. They just don’t seem to have enough knowledge about their own bodies and normal birth to know otherwise and often times the midwives don’t know any better either. It’s not that different than in the U.S. actually, where women are given umpteen reasons why they need a c-section and they don’t really protest.
There are also situations where the midwife doesn’t know her stuff, but this environment makes it especially challenging for a midwife who might say “this is outside of my parameters, we should go to the hospital”—because then the family has a big discussion about whether to go or not, knowing that they will be treated very badly once they get there. Then the question becomes, at what point is it worth it to go?
I have also experienced the loss of a beautiful baby boy due to the utter incompetence of the health care system I dutifully referred the family to. Instead of being treated, the situation was dismissed (by the local health post doctor) as a result of the evil eye. A few days later the baby died. I am still grieving over the recent loss of this baby, my first as a midwife, and dumbfounded at the whole situation. Healthy women with healthy pregnancies are being told there is something wrong and a sick baby, who needs urgent attention, is dismissed. It makes no sense.
On a more positive note, I have attended some really triumphant home births, where women have had their babies at home with me and a “comadrona” attending, against all pressure to go to the hospital. The depth of gratitude I have received from the women and their husbands, often the most from their husbands, makes everything I am doing worthwhile. I can really, really feel how deeply important it is to these people to have their babies at home with their families and their midwives. It’s deep stuff.
For me, I care deeply about woman and babies surviving the birth process. But the point I want to get across is that birth, and life, for that matter, is not just about survival. All of life is here to be cherished. Birth is one of life’s most exquisite experiences, or I should say it can be. For some women, maintaining their dignity and freedom is more important than staying alive. Others are willing to sacrifice the home birth and endure the hospital experience in favor of what they believe is their safety. They should not have to make that choice. They can have their babies in safety, dignity, and freedom, all at the same time.
The goal of the midwifery school is not only to equip midwives with knowledge; it is to elevate the status of midwives so that we can improve birth outcomes and lower intervention rates. Ideally, we would like to offer a comprehensive three-year midwifery education to younger midwives just starting out so that there can be a group of professionally trained midwives who are well-steeped in the midwifery model of care as well as their own culture. These midwives would fill a huge void in the community between birth with a traditional midwife, or “comadrona,” who has minimal training, and a c-section in the hospital. These women could serve as bridge builders with a valuable knowledge base of normal birth and the ability to communicate in both the indigenous communities and the medical world. We hope our students will be the leaders of the future of midwifery in Guatemala.
MA: You have described this project as a dream-come-true. It is inspiring to hear. Tell us about that.
SP: The more this project develops the more I have deep faith in the process and what will be the product. It feels to me like there is a spiritual force that has created an energetic blueprint of what it wants to create. Each of us holds a piece of the manifestation of that blueprint and have joined the effort because we are somehow aligned with it. For myself I feel like I’m just following instructions. I just feel like I trust everything that shows up and the more I do that the more I see results that blow my mind. Every meeting is productive, every action moves us forward. Every door knocked on is opened. It’s crazy and awesome.
Sarah Proechel is a Certified Professional Midwife from the U.S. She has had a private home birth practice in western Massachusetts since 2005 and is currently working in Guatemala as a 2010-2011 Fulbright fellow. Her project, a cultural exchange with traditional midwives in San Marcos La Laguna, Guatemala, has rapidly evolved into a joint initiative to create an international professional midwifery school. Sarah holds a bachelor’s degree from Goddard College in Health Arts and Sciences with a focus on Mayan midwifery and herbal medicine and is currently enrolled in a Master of Midwifery program at Midwives College of Utah. She is author of Voices of Maya Midwives: Oral Histories of Practicing Midwives from the Mam Region of Guatemala, Lulu press, 2005. When she’s not in Guatemala, she lives in the Hudson Valley of New York State with her husband, two young children, and one teenager.