The changing role of indigenous lay midwives in Guatemala: new frameworks for analysis

Midwifery. 2013 Aug;29(8):852-8. doi: 10.1016/j.midw.2012.08.011. Epub 2013 Feb 12.


Objectives: to examine the present-day knowledge formation and practice of indigenous Kaqchikel-speaking midwives, with special attention to their interactions with the Guatemalan medical community, training models, and allopathic knowledge in general.

Design/participants: a qualitative study consisting of participant-observation in lay midwife training programs; in-depth interviews with 44 practicing indigenous midwives; and three focus groups with midwives of a local non-governmental organization.

Setting: Kaqchikel Maya-speaking communities in the Guatemalan highlands.

Findings: the cumulative undermining effects of marginalization, cultural and linguistic barriers, and poorly designed training programs contribute to the failure of lay midwife-focused initiatives in Guatemala to improve maternal-child health outcomes. Furthermore, in contrast to prevailing assumptions, Kaqchikel Maya midwives integrate allopathic obstetrical knowledge into their practice at a high level.

Conclusions and implications: as indigenous midwives in Guatemala will continue to provide a large fraction of the obstetrical services among rural populations for many years to come, maternal-child policy initiatives must take into account that: (1)Guatemalan midwife training programs can be significantly improved when instruction occurs in local languages, such as Kaqchikel, and (2)indigenous midwives' increasing allopathic repertoire may serve as a productive ground for synergistic collaborations between lay midwives and the allopathic medical community.

Keywords: Guatemala; Indigenous health; Lay midwifery; Traditional birth attendant.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Female
  • Guatemala
  • Health Knowledge, Attitudes, Practice*
  • Health Services, Indigenous / standards*
  • Humans
  • Interprofessional Relations
  • Maternal Health Services / standards*
  • Middle Aged
  • Midwifery / education*
  • Nurse Midwives / education*
  • Nurse Midwives / statistics & numerical data
  • Professional Role*
  • Qualitative Research