Kaqchikel midwives, home births, and emergency obstetric referrals in Guatemala: contextualizing the choice to stay at home

Soc Sci Med. 2006 Apr;62(8):1958-69. doi: 10.1016/j.socscimed.2005.09.005. Epub 2005 Oct 11.


Maternal mortality is highest in those countries whose health budgets are restricted. Practical strategies employed in the International Safe Motherhood Initiative, therefore, must be both effective and economical. Investing in emergency obstetric care resources has been touted as one such strategy. This investment aims to insure significant improvements are made in regional health centers, and a chain of referral is put into place so that only problem cases are attended by the most skilled health workers. This article examines how this model of referral functions in Sololá, Guatemala, where most Kaqchikel Mayan women give birth at home with a traditional midwife, and no skilled biomedical attendant is available at the birth to make a referral. Ethnographic data is used to explore reasons why women do not go to the hospital at the first sign of difficulty. I argue that the problem frequently is not that Mayan midwives, their clients and families fail to understand the biomedical information about dangers in birth, but rather that this information fails to fit into an already existing social system of understanding birth and birth-related knowledge.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Choice Behavior*
  • Culture
  • Female
  • Guatemala
  • Health Knowledge, Attitudes, Practice
  • Home Childbirth*
  • Humans
  • Interviews as Topic
  • Maternal Mortality
  • Middle Aged
  • Midwifery*
  • Obstetrics and Gynecology Department, Hospital / statistics & numerical data*
  • Pregnancy
  • Pregnancy Complications
  • Referral and Consultation*