For centuries midwives in rural Guatemala have played a key role in delivering babies despite the numerous challenges.

Chiquirichapa, Guatemala – Antonina Sanchez Mendez vividly remembers the first time she delivered a baby.

The only tool she had was a razor to cut the umbilical cord.

“I didn’t know what to do,” she tells Al Jazeera.

“When the baby was born, I was trembling and sweating,” she recalls.

Although she wanted to keep the experience private, the mother – a friend of Mendez – whose baby had just been delivered told others in the small Guatemalan town of Concepcion Chiquirichapa about her experience, prompting pregnant women to begin seeking out Mendez for help.

That was more than 19 years ago. Since then, Mendez has helped deliver hundreds of babies, taking on a vital role in her community where there’s a shortage of traditional indigenous midwives.

High mortality rates

In Guatemala, indigenous women are twice as likely to die during pregnancy or childbirth as non-Indigenous women, and Indigenous infants are two-thirds more likely to die than non-Indigenous infants.

This is compounded by the fact that indigenous Mayan women are less inclined to go to the country’s Ministry of Health facilities due to language barriers, the lack of understanding of indigenous traditions and the expense.

An appointment with a midwife costs about 10 Quetzales ($1.40), but a consultation with a doctor between 50 and 100 Quetzales ($7 and $14) per visit.

Such challenges, as well as the value found in traditional medicine, have made midwifery within indigenous communities like Mendez’s even more important, but a strained relationship with the government over the years has contributed to the shrinking network of indigenous midwives.



According to the World Health Organization, the maternal mortality rate in indigenous communities is 200 to 300 women per 100,000 live births in Guatemala [Ali Rae/Al Jazeera]



Complicated relationship

A government-run training programme for midwives was started in 1969 as a result of the creation of the Division of Maternal and Child Health.

Since the training programme began, only midwives who attended it and received a certificate were authorised by the government to help with deliveries and register newborns.

In some municipalities, the training programme is taught in Mayan languages. In others, however, animosity towards the traditional practice prevails.

“The government is trying to make an effort to integrate both visions, but it has proven to be difficult,” says Oscar Barreneche, a representative with the World Health Organization in Guatemala.

Despite the improvements, many obstacles remain.

“There is still a very patronising attitude towards these healers,” he says.

“They are not always included in all the efforts, and the value of her practices is not always recognised.”

Midwives, including Mendez, also feel this exclusion when trying to do their work.

“In hospitals, they believe midwives can’t take care of births because we don’t have a degree,” Mendez says.

“They believe we don’t know how to do our work, but thank God – because of the training we have received – we know what births we can take care of and which ones we can’t.”



The expense and lack of access to modern healthcare have made midwifery even more important within indigenous communities [Ali Rae/Al Jazeera]



Rescuing the tradition

Although Mendez says this has contributed to a shortage in the number of women who want to become midwives in her own community, she remains dedicated to keeping the ancient tradition of midwifery alive.

“If the midwives died without training the new generation, the culture dies with them. There are a lot of traditions involved,” she explains.

Mendez receives women at all hours of the day and night. Many arrive for prenatal consultations, or to find relief for pain. Sometimes they come for abdominal massages.

She and others in Concepcion Chiquirichapa, which is about 214km west of Guatemala City, formed an organisation of midwives to strengthen their efforts and educate future generations.

The group built the first Mayan birth centre with two temazcales (a traditional steam bath), a natural medicine laboratory, and eight delivery rooms. They also have an ambulance and the support of volunteer doctors who take turns in emergency cases.

For the women in Concepcion Chiquirichapa, Mendez and other midwives make the process of childbirth more accessible.

“When I met Antonina for the first time, I knew she was the person that I wanted to help me the birth of my kids,” Lucha Escobar tells Al Jazeera.

“Having my babies with her was a unique experience, thanks to her, and to her immense gift, the birth of my two children became a beautiful experience, in the warmth of my home and surrounded by my loved ones.”

Reporting for this story was supported by the International Women’s Media Foundation as part of the Adelante Latin America Reporting Initiative.