The Safe Motherhood Course in Guatemala
Both of us began our course today along with our Guatemalan teammates. We have 15 students: 10 are practicing birth attendants, 2 are new comadronas, and the rest are staff at the small hospital where we are teaching. We want to offer our input on the questions you asked.
Why Did we Start this Program?
We developed this project in response to a request from a committee of birth attendants in the department of Solola, Guatemala. In this rural area which is predominantly Mayan, 70 percent of women birth at home assisted by a birth attendant or “comadrona” as they are called. Local maternal mortality rate was 3 times higher than the reported national rate and the committee was concerned.
How does the Health Care System work?
In the department of Solola 70 percent of women birth at home under the care of a comadrona. There are two systems of health care in Guatemala: public system provided by the government and a private system driven by physicians. In the public system, health services are free of charge theoretically; however, the facilities have few resources and lack medications and supplies. Staff have good knowledge but very little practical experience when they graduate from their health program. Each department in Guatemala has one funded national hospital and each municipality has a public health center or health post. For most communities, the hospital is several hours away on dangerous mountain roads. We believe that the funding for this program comes from an NGO and not primarily the government.
What about Prenatal Care and Contraception?
A pregnant woman can receive prenatal care from the health centre where she can get vaccinated, and also from her comadrona. The number of women seeking prenatal care is also increasing, but there are still several women whose first contact with care is when they go into labor. The health centre have personnel available 24h per day and women are encouraged to go there for their delivery, but there is no advantage over a home birth because the health centres are so poorly equipped. A woman can access birth control free of charge at the public health centres. Contraceptive use is increasing over time, but more education is needed especially for the men.
How do our Courses Work?
Our Guatemalan colleague, Cenaida, contacts the nursing director at the public health centre who then contacts all the known comadronas in the community and invites them to our course. Whoever shows up on the first day is accommodated up to a maximum of 35 students per class. A class size of 20 is better due to the practical nature of our course. We have also accepted students who are first aid attendants, community health promoters, and firemen who provide the ambulance service in various communities.
Our course outline is available on our website at www.safemotherhoodproject.org. We now give a five day course instead of the four day course provided. The content is the same but with 5 days we have more time for discussion and practice.
Which Resources do you use in the Course?
The resources we use are described below:
- We have a manual to complement the course content designed for students who can’t read. It is adapted from a manual developed in the ‘70s by UNICEF. For those who can read it also has script. We would be happy to share this manual.
- We use 3 Simulaid obstetrical pelvic models. They include wearable pregnant bellies with baby and fluid for determining fetal position.
- Television and DVD player. The DVDs we show are: The Stages of Labor, and Successful Breastfeeding from InJoy media.
- We use 4 resuscibabies from Laerdal for teaching neonatal resuscitation.
- We have knitted breasts for demonstrating a good latch for breastfeeding.
- We use clinical supplies for examining real prenatal patients like BP cuff, stethoscope, Pinard horn, Doppler, measuring tape.
- Mattresses and sheets.
- We use pitchers and soap and nail clipper and nail brushes.
- We also use birthing supplies for demonstration including: headlamp, cord ties, scissors, gloves, Q tips and Alcohol, Erythromycin ophthalmic ointment, a camp stove, a pot and 2 forks, a plastic sheet for the bed, and an apron.
- We have posters of anatomy, stages of pregnancy, contraception, emergency planning, and obstetrical risks.
- We ask the community to provide a room big enough for the class, a bathroom, and a water supply, and electricity.