Teaching—and learning from—comadronas

Last week, I traveled to Santiago, a small Guatemalan town that sits beneath a ring of volcanoes and beside the shore of Lake Atitlan. The women of Santiago de Atitlan dress as they have for centuries, in hand-embroidered huipil shirts and long skirts wrapped around their small frames. Here, the Mayan language of Tz’utujil has been preserved, alongside the more official Spanish. In this community rich with culture and custom, Saving Mothers has launched a school for comadronas, traditional Mayan birth attendants who have long worked in the region but receive little formal training. For a few days, I was fortunate enough to shadow Jessica Oliveira, Saving Mothers’ Project Manager in Guatemala, as she taught the Comadrona School of POWHER (Providing Outreach for Women’s Health Education and Resources).

Classes take place in an airy, sun-lit room located above La Voz de Atitlan, the local radio station. Here the comadronas gather twice a week to learn the nuances of prenatal visits, complications of labor, and pertinences of postpartum care. Having played a small part States-side in putting together resources for the curriculum, I’d been invited across the world and into this classroom. But I quickly learned that the space is also one in which the women find their voices, where they can talk about the changing role of comadronas in the 21st century and their own experiences of birth. None of this would be possible without the brazen Jessica Oliveira, who creates discussion by interweaving worlds, spinning together her experiences in a Big Apple academic center and around Lake Atitlan. She throws herself into this convergence wholeheartedly, demonstrates concepts with her body, lends her ears to the women who convene for class each week. 

And so, it is also here in the classroom that many young women, some of whom fall into a matrilineal lineage of comadronas within their own families, wrangle with how tradition can work alongside modern medicine. Meanwhile, the older members in the group graciously consider additions to their practice and seek to understand the source of these new suggestions. Young and old, it will be the task of these women to unify the beliefs of science and society in their practice.

This is tall order for anyone, and seems especially so for these ladies who are small in stature, hardly five feet in height. But it would be a mistake to underestimate this group. In fact, their spunk and spirit for learning overwhelmed me from the start. Despite the extensive educational opportunities I have been afforded as a first year medical student, I was immediately humbled by the real world experience and skills these comadronas possess. They think through medical cases in the classroom, but their work takes place in the wider community.

For this reason, I had especially anticipated the chance to accompany a few comadronas on their prenatal home visits. So, towards the end of the week, we stood together in the bed of a pickup truck that swung along the roads outside of Santiago, taking us to the rural aldea, or village, of Tzanchaj. Here too, I was not only invited into each modest household, mostly drywall and dirt floors, but also welcomed to examine the exquisitely intimate space that is a woman’s body. For weeks, my head had been enclosed within a high-rise built of medical books; but now, my tasks were to conduct an interview in Spanish, measure the fundal height, and feel a baby growing inside the bulging uterus. And while I found myself hesitant with my hands, as if I had only just recognized myself outside academia and was made nervous by the potential to cause harm, the comadronas beside me channeled the knowledge they had gained from belonging to a cultural tradition and especially the school. They went about their work with confidence and care.

From these powerful women, I learned more than can be marked with the tape measures we carried to determine fundal height or calculated with the pregnancy wheels we were constantly turning. It is difficult to quantify, but I have attempted to weigh the experience in words—and I believe the term aldea global provides the closest approximation of my appreciation.

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