Focus Group with Guatemalan Traditional Midwives about Postpartum Hemorrhage

Guatemala, midwives, postpartum, hemorrhage, childbirth, obstetrics, focus group Traditional midwives attend the majority of births in Guatemala (Maupin, 2008; Walsh 2006; Walsh 2003), yet evidence from Lang and Elkin’s landmark article (1997) shows traditional midwives in Guatemala lack basic skills to prevent and treat postpartum hemorrhage (PPH). Most traditional midwives are indigenous and work independently outside of a formal health care system. They may or may not have formal training for their role, and typically have been recognized by their community as trusted women who have accepted a spiritual calling (Walsh, 2006; Walsh, 2003). Midwives’ lack of knowledge about managing PPH is particularly troubling given that PPH is the leading cause of maternal death related to childbirth in Guatemala and accounts for 50% of maternal deaths (International Confederation of Midwives, 2009). According to the International Confederation of Midwives (2009), the Maternal Mortality Rate in Guatemala is between 156 and 270 deaths per 100,000. This figure is three times higher for Guatemalan indigenous women than for non-indigenous (Roost, Johnsdotter, Liljestrand, & Essen, 2004). Although self-proclaimed midAbstract The purpose of this qualitative, pilot descriptive study was to explore Guatemalan traditional midwives’ knowledge, practices and attitudes about nursing interventions to manage postpartum hemorrhage (PPH). One 45-minute focus group was conducted among 13 traditional midwives at a rural health clinic that had limited resources and was located in remote central eastern Guatemala. The Long Table Approach was used to develop a matrix of common themes. Traditional midwives repeatedly asserted that they had never managed PPH despite a combined 197 years of midwifery service. Midwives expressed trust in local health care providers and said they would transfer patients to hospitals in emergencies. Midwives requested help educating villagers about the importance of prenatal care and of seeking early labor support. Limitations of this study include social desirability, lack of generalizability and variability. Future interventions should consider educating villagers, including men, as well as midwives about PPH or other prenatal care and labor support. www.ojccnh.org