Midwife

This week we had a special presentation on Wednesday from a local midwife, una comadrona. She works in a nearby community with a group of 60 other midwives to serve nearly 2000 people. She represents generations of information passed down through conversation and demonstration. She explained that women will come to her if there period arrives late in life (after 16 years old) or arrives early (before 10), pregnancy, and during the first five years of life of a new child.

She began by explaining the pregnancy process. The pregnancy is first detected by physical changes in the woman’s body, such as the absence of a period and darkening of the nipples, since you cannot see inside the woman. The woman is advised to avoid coffee, chili, alcohol, and cigarettes. There are several teas made from various plants around the community which are used at specific moments in the pregnancy. Each tea serves a purpose. The comadrona passed around examples of many of the different plants. The majority of them are local plants that are unfamiliar to us but one was chamomile.

During the seventh month, the baby must be positioned so that the head is pointing downward. This is the appropriate position for a safe birth. If the baby is side ways or inverted, the midwife will slowly massage the women’s belly to rotate the baby. She said it is important not to confuse the head with the butt as you rotate the baby. They do not use any ultrasound equipment to confirm, only their hands. If it is difficult to rotate the baby (because an arm or leg is blocking the way), she will try to rotate the baby in the opposite direction. This massage concerns me because there seems to be no awareness of the umbilical cord. If the baby cannot be rotated entirely, the midwife will refer the woman to a hospital for birth. According to the comadrona, 80% of her communities’ births are by midwife and 20% are hospital births for complications.

When a woman begins contractions, she will drink a tea. If the pain increases, they know the woman is beginning labor rather than false contractions. During labor, the woman is encouraged to walk to alleviate discomfort. When the woman can no longer take two steps, the midwife knows the birth is near. Recently, the midwives learned to use gloves and measure dilation. However, before, they used physical signs to tell. A cloth belt is also wrapped around the woman’s hips for pressure. A woman can give birth in three positions – lying on her back (what you traditionally think of), kneeling, or squatting. In each position, the midwife performs different massages to comfort the woman and encourage the birth. Typically, the father is not present. Other family members and friends may be on hand to support but sometimes the woman prefers to be alone.

After the birth, the mother is washed in a steam bath house. The comadrona creates a bathwater for the same plants as the tea to wash the mother. She also uses a special soap (jabon negro) made from fat and ashes. The mother is washed and massaged for 25 minutes. This massage includes massaging the breasts to promote lactation and beat the body with the leaves of the plants. If there is vaginal tearing, hot leaves will be pressed against the skin to promote healing. However, if there was a lot of hemorrhaging during birth, the entire bathing process will be delayed. The midwife demonstrated this massage and slapping on Jefe, a boy volunteer from our group. Although this is a very serious moment, we were all holding back (but not very well) our laughter. Imagine a six foot lanky college boy having his “breasts” massaged and being slapped with leaves by a woman under five feet and easily sixty years old. She even had him kneel on his hands and knees as she pinched his butt to imitate the vaginal heat process. He said he was biting his lip to avoid bursting into laughter himself.

The newborn baby has a similar but less hot bathing process. The wrapping and clothing of the baby serves several ceremonial points. A scarf is wrapped around the head, over the shoulders, and ties on the chest to mimic the physical stress men and women endure on his head and back while working. The blanket is hung around the feet to request a pain-free menstruation for women and remind men to return to the comforts of home at old age. Then a pencil and money are placed in the baby’s hand for good education and financial success. The girls also receive a weaving tool for good skill in creating clothing. Lastly a salted chili is placed in the baby’s mouth to prevent him or her from speaking poorly in the future and using bad words. The hands are also bound down by the baby’s sides for 15 minutes to prevent the baby from touching everything as 3 and 4-year-olds do. Finally the babies are wrapped in another blanket and given to the mother.

I was very intrigued by our demonstration. I asked a large number of questions and want to visit her in her community to see all this in action. As many of you know, I despise pregnancy and have no current inklings to have children. Nonetheless, this is quite fascinating. Alternative, rural, and traditional medicine combined.

The comadrona has no formal training but says she is able to read and write. The majority of the women in her community only speak the indigenous language (not Spanish). For this situation, it is very scary for women to give birth in a hospital. They do not understand the treatment that is provided. They can also only give birth in the laying down position (which isn’t always best, according to the midwife). An additional concern is that in the hospital the woman will be alone in the room. Her family and husband are not allowed in the delivery or pre-delivery room. Occasionally the mother is allowed to be with her daughter who is giving birth.

Side note: my current Spanish teacher Miriam gave birth in a public hospital. Her plan was to deliver in a private hospital but her physician was unavailable and she was starting labor. Turns out her private physician was serving public service hours in the same public hospital and was able to deliver her son. Once she was admitted, she was not allowed to leave and go to a different hospital – as per hospital regulations. Her husband was not allowed in the room with her and she was not allowed to eat during labor (which lasted more than 15 hours). She kept telling the nurse her stomach hurt with hunger but they would not allow her to eat. She gave birth after the kitchen closed and did not eat until much later.

From Hannah: two of our host mom’s three daughters were delivered at her house (not sure if that is this house or another)