Midwife Epifania Elías Gonzales examines Delfina Vicente López inside Vicente’s home on a remote hilltop not far from San Carlos Sija, Guatemala. During her 30-year career, Elías has helped hundreds of women in her predominantly K’iche’ speaking Indigenous dialogue.

TEXT BY MEGAN JANETSKY – PHOTOGRAPH BY JANET JARMAN

MARCH 29, 2022 – NUEVO SAN ANTONIO, GUATEMALA. In a dimly lit green bedroom in Guatemala’s western highlands, the 66-year-old midwife chants the words like a prayer, mixing Spanish and her K’iche’ Indigenous language as she cradles the woman giving birth on the ground before her.

“Breathe. Breathe, mija,” says Epifanía Elías. “You have to breathe. Be strong.”

Her patient, 25-year-old Leidy Chavez, writhes in pain, gripping the thick wool picnic blanket she has laid on the floor of her family’s home. None of Chavez’s family members are present, but Elías and her sister-in-law provide some comfort by gently stroking her hair.

In this tiny mountain village of stretching corn fields, where access to running water is scarce and basic healthcare services limited, pregnancies tend to be high-risk, according to the region’s health official. Indigenous midwives like Elías are the frontline soldiers in the battle to reduce maternal and infant death—not just in Guatemala but across other parts of Central America and southern Mexico.

“They’re the women improving access to healthcare, because often women can’t go to places like health centers to give birth,” says Edgar Kestler, director of Guatemala’s Epidemiological Research Center in Sexual and Reproductive Health.

Guatemala has the highest maternal death rate in Latin America, according to a 2017 report from the World Bank (the most recent data available). In this country, 115 mothers die in childbirth, compared to the regional average of 87 per every 100,000 births. Infant mortality rates are even higher with two of every 100 children dying in birth.

“Such alarming figures can be attributed to the extremely low levels of formal prenatal and delivery care, especially in rural areas,” the World Bank report states. “Almost three-quarters of maternal deaths are among women of Indigenous ancestry.”

The fight to save mothers and newborns doesn’t usually take place in hospitals with well-staffed, well-equipped medical teams. It happens in bare-boned rooms like this one where Chavez is giving birth, hours from a hospital. As the sun sets over the distant mountains, the room gets quiet except for Elías softly whispering to the birthing mother, “ya está llegando”— here she comes. Seconds later, an eruption of cries comes from the newborn who gets swaddled in a sea blue blanket.

With mother and daughter now out of danger, Elías soon shifts her attention to other expectant mothers. She sometimes walks hours to reach patients, her simple medical bag slung over her shoulders in a red woven Mayan cloth.

The work done by midwives has become even more essential during the COVID-19 pandemic. Hospitals have struggled to stay afloat, and patients have been turned away from health facilities. Women like Elías fill in the cracks.

“We’re doing what the health system doesn’t,” she says. “We work more than the doctors, and we’re the ones helping women. Midnight. 1 a.m., 2 a.m., at any hour. When they call, … you have to go to the patient.”

Evolution of midwives

Here, in the remnants of the Mayan empire, a region spanning from southern Mexico to northern Central America, Indigenous women have been passing on the tradition for centuries. Known as parteras or comadronas, midwives were some of the region’s first healthcare providers.

The practice is believed to be a talent bestowed upon women, often handed down generation-to-generation. Mother to daughter, daughter to granddaughter.

As a young woman, Elías would watch her mother care for pregnant women, going house-to-house to do prenatal checkups, working with herbal medicines, delivering babies, and doing traditional steam baths called “temazcal” after the births.

Elías herself didn’t begin the work until she delivered her own baby, alone, on the floor of her kitchen. Her mother was off treating another patient when Elías, then 35, went into labor.

“I felt the baby was about to be born, so I woke my husband up and told him ‘Get up, the baby is coming.’ He told me ‘no, no, no. I don’t want to do it. Ay, I’m scared!’” she remembers.

“But I didn’t feel scared. I felt strong.”

She went on to become one of at least 22,000 traditional midwives working across Guatemala and 15,000 in Mexico, according to government figures. In Guatemala alone, comadronas deliver half of the country’s births.

WUNRN

National Geographic