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J uana Cac Perpuac sits on the grass outside the health centre in her town with a look of desperation and disbelief in her eyes. She fears the worst for the woman she is looking after. They fulfil a role similar to that of a doula: they help deliver babies, perform massages before and after birth, and use medicinal plants to ease pain and stimulate breast milk.
There are 23, comadronas registered with the Guatemalan Ministry of Health and they are often older women. They perform a vital role in hard-to-reach areas, where it can take hours to get to the nearest hospital by truck or foot along dirt tracks — which often comes at great expense — and in communities where Mayan beliefs and practices still play a part in everyday life.
In the past they would be the closest person to a doctor women would see during childbirth. Now the situation is changing. In an effort to reduce maternal mortality rates in the country, the Ministry of Health has been working with comadronas to ensure more births happen in designated centres — including hospitals and smaller clinics in the community — with trained healthcare professionals present. But the work of women like Cac Perpuac is still necessary.
The national maternal mortality rate in Guatemala [pdf] is per , births, compared to nine in the UK. In Quetzaltenango, there were more in than two years previously. Comadronas are now required to register with the Ministry of Health and attend monthly training, where they learn to detect danger signs like whether the baby is in breach position, or if the woman has a fever and abdominal pain. In such cases, they are encouraged to take their patients to the nearest health centre.
Comadronas are looked down upon by medical staff, who ignore them when they have concerns and yet tell them off for bringing women to hospital too late. In some cases, they are not allowed to stay with their patient and are forced to wait outside the hospital. Indigenous women also face discrimination — they are patronised and berated for turning up with dirty feet after walking to hospital and for screaming in pain during childbirth. There have been stories of them being sterilised without informed consent.