Guatemala Field Notes From An American ObGyn


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Dr. Heidi Flagg visiting Every Mother Counts’ grantee partner, ACAM. Every Mother Counts’ support of ACAM is helping to provide comprehensive health care, support education clinics for local midwives and other health care providers to build their knowledge and skills, and is helping to provide transport and referral linkages to higher level facilities for women.

Another meaningful, soul-fueling trip with Every Mother Counts has wrapped up. Mothers from New York City and San Francisco accompanied their kids to meet the Every Mother Counts grantee partners in Guatemala.

After two prior trips with Every Mother Counts to Tanzania and Haiti, I am now familiar with the feelings that rise to the surface the second I step foot in a low income country like Guatemala. A long mental list of ways to contribute starts forming at lightening speed. Inspired by the optimism of Elliot, my 15-year-old son during and after this trip, I felt more sanguine this time. He said, “What surprised me was how little the midwives had to work with, but how they made use of everything” and “they seemed so happy!” There is nothing like a youthful, unencumbered viewpoint to infuse hope and positivity!

As an ObGyn practicing in downtown NYC, witnessing the challenges facing Guatemalan women overwhelmed me immediately. These women, and indeed girls, face many challenges stemming from political, economic, and cultural inequality. Forced marriages before 18 lead to increased partner violence and pregnancy complications.

There are many challenges and barriers to extending help to places like Guatemala, Haiti, and Tanzania. Among the impediments are religion, culture and simple logistics. For example, a $150k ultrasound unit, a valuable tool in obstetrics, delivered to a war torn hospital in Liberia, sat in a corner gathering dust. Not only was there no one trained to use the machine, but also the lack of consistent electricity prevented powering the machine up.

The saunaWe visited the Association of Midwives of the Mam Speaking language (ACAM), a grantee partner of Every Mother Counts. Almost immediately, I observed a blend of the traditional Mayan approach and Western medicine. The Mayan women utilize herbal and other natural remedies in labor, the post-partum period, and nursing. But, they were openly embracing medical options, like antibiotics, pitocin, a fetal doptone and ultrasounds in rendering informed and culturally sensitive care to their patients.

As part of our tour, we were shown the sauna, where a new mother spends time immediately after delivery for a session of massage and sweat with her midwife. This ritual promotes blood flow, hormone release, healing, and milk production. I peered into a small, dimly lit, stone room, accessed only by ducking through a diminutive, Alice in Wonderland-like doorway. The smell of wood smoke permeated the space. The room was equipped solely with a stone bench, a water spigot, and a bucket.

In a second, sparsely furnished room were two makeshift gurneys and an ultrasound machine! While appearing to be from the 1960s, the machine functioned well enough for training purposes and obtaining basic ultrasound information, such as fetal position, heartbeat, dating and location of the placenta. The midwives hummed with excitement about their “new” ultrasound machine, accompanied by regular training from a Boston radiologist. Hope and positivity!

Medication roomOther rooms included a very well-stocked medication room, a room for crafting remedial herbs, birthing rooms, and a prenatal and gynecological exam room. The impressive set of neatly labeled and displayed medications included the familiar pitocin and methergine, which are useful in preventing post-partum hemorrhage.

Next came the highlight of the trip for me. We met Imelda, one of ACAM’s comadronas (traditional midwife in Spanish). Mallory, a visiting CNM from Seattle, facilitated our conversation. Over lunch, Imelda shared her story. Imelda plays a vital role in ACAM, not only as a midwife, but in running the organization. Our contrasting worlds had amazing overlap. We both provide care to women, have administrative roles in our practices, and came to our life calling through family. Imelda learned from her mother, a midwife, and I from my father, a surgeon.

Starting with a few basic questions, I learned that ACAM does about 100 deliveries a year, a number which is building as the word reaches the community through the mobile clinic that Every Mother Counts supports and word-of-mouth.

Like with my own group of doctors, we gravitated towards discussing our most distressing case on-hand. Imelda and Mallory shared a recent story involving an example of one of the more difficult clinical scenarios we providers face: informing a mom that her baby has passed away. With the help of the newly acquired ultrasound machine, the midwives diagnosed a mother nearing her due date with her third intrauterine fetal demise (IUFD). Imelda’s recommended a referral to the mother to the nearest hospital to induce labor. The patient refused. Convinced her baby was still alive and moving, the mother insisted on returning weekly to ACAM to check the baby’s heartbeat. Heartbreaking, just simply heartbreaking.

After hearing this patient’s history, I was certain a weekly injection of blood-thinning medication would have significantly reduced the chance of complication. Alas. It is difficult to describe the emotions evoked upon hearing a story like this — frustration laced with anger at the unfairness, regret, and guilt. Why is care and access so different from person to person, place to place?

Imelda, second from the left. The local and traditional midwives, or comadronas, are some of the founding members of the Asociación of Comadronas of the Mam-Speaking Area (ACAM), established in 2004 to provide quality reproductive, maternal and newborn care.

We remained happy and hopeful when Imelda shared the story of her first solo delivery. Not yet formally trained at 18 years old, a woman in active labor came to the house in search of Imelda’s mom, who was not at home. Left with no other option, Imelda tended to the woman. She led the woman into a room with a bed, and drawing from what she watched her mom do, examined the patient. Something wasn’t quite like she remembered. This patient’s exam was different, confusing. The second stage of labor was in full force, the patient was in pain and pushing. Imelda revealed, “she was Breech.” (Breech presentation is defined as delivering buttocks or feet first and has a higher risk of complications). This is the moment that my heart stopped. The terror of Imelda’s predicament, so very real to me, but under very, very different circumstances — no hospital, no hemorrhage team, no operating room, no safety net. Imelda said she was scared, but channeling her mother’s techniques, supported the mother and the baby. A 5-pound baby girl delivered and cried right away! Mom and baby were okay. What a relief! Imelda shared that she knew at that moment that she wanted to follow in her mom’s footsteps and become a midwife. Inspiring!

As with other EMC trips, I learn so much each time. The biggest lesson driven home this visit was not imposing my context on others. The ACAM midwives work within a minimalist arena by any American standards. And yet, they affect change going from woman to woman, blending their traditional birthing techniques with Western-style medical techniques to optimize survival for both mom and baby as best they can.

Every Mother Counts navigates these challenges beautifully and seamlessly. Christy and her team form close relationships within the organizations that they support, building the trust needed to overcome cultural differences. The basic essence of this positive impact was clearly visible through the eyes of the kids who accompanied their moms on this trip. Thank you Christy and Every Mother Counts, thank you!

This article was republished from Every Mother Counts.

See also:
Maya Midwives As Social Workers In A Machista Society
For Native Mothers, A Way To Give Birth That Overcomes Trauma

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Daily Astrology

November 13, 2019

During the wee morning hours the Moon enters Gemini. Curiosity is piqued and tongues are ready to wag. The focus on ideas and information is intense today. Retrograde Mercury slips into a sextile with serious Saturn and a trine to dreamy Neptune…
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November 2019

No matter how broken or damaged you may feel, there is a deep well of stillness inside of you that is always there! Connected. Whole. Unchanging and Ever present. Yoga Nidra or Conscious Sleep...

Cost: $20 each session

Where:
YogaLife Institute of NH
6 Chestnut Street
Lower Level
Exeter, NH  03833
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Sponsor: YogaLife Institute of NH
Contact Name: Alice Bentley
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Come shine with us! Join us in harmony and in our goal to bring the light of Spiritualism forward to all those who are searching.

Where:
VFW Post 2597
775 Boston Rd, Rt 3A
Billerica, MA
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Sponsor: The Spiritualist Fellowship Church Of New England
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A beautiful collection of messages from Jeshua Ben Joseph (Jesus) that will transform your life, as it did his. Coming together to study these teachings, to ponder, to savor, to deepen our...

Cost: $25 per class

Where:
Heart and Soul Holistic Healing Center
130 Massapoag Avenue
Sharon, MA  02067
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Sponsor: Heart and Soul Holistic
Telephone: 781-258-9942
Contact Name: Barbara Ann Strassman
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In gratitude for your service, please join us at Dragonfly Wellness Center at 176 Jackson Road, Devens for refreshments and complimentary 15 minute sessions of: Chair massage Shamanic...

Cost: Free

Where:
Dragonfly Wellness Center
Dragonfly Wellness Center
176 Jackson Rd
Devens, MA  01432
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Sponsor: Yoga Anita
Telephone: 978-227-8297
Contact Name: Anita Perry
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2nd and 4th Monday of every month This psychic message circle is for anyone wishing to raise their connection using their psychic centers known as the “clairs.” Learn how to use...

Cost: $20

Where:
Messages From Heaven Healing and Learning Center
646 Central Street
Suite 3
Leominster, MA
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Join us at our free Boot Camp created specifically for post-divorce issues! About this event: Make new connections while learning essential strategies for building your post-divorce life with...

Cost: Free

Where:
RMS Residential Mortgage Services
465 South Washington Street
2nd Floor
North Attleboro, MA  02760
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Sponsor: Vesta: Redefining Divorce
Telephone: 508-744-6014
Contact Name: Deanna Coyle
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Come join us for a guided drumming circle to celebrate the November “Beaver” Moon. Arlene Dorischild will lead fellow drummers in a celebration to honor this special lunar event....

Cost: Donation

Where:
Peaceful Creations LLC
382 Boston Turnpike
Suite 102
Shrewsbury, MA  01545
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Sponsor: Peaceful Creations LLC
Telephone: 617-208-3333
Contact Name: Rebecca Resnik
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Free Evidence-Based Holistic Health Education Program at Wilbraham Senior Center The H.E.A.R.T. Program® (Health Empowerment and Real Transformation), created and instructed by Michelle...

Cost: Free

Where:
Wilbraham Senior Center
45 Post Office Park, #4502
Wilbraham, MA  01095
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Sponsor: Harmony Way
Telephone: 413-636-2475
Contact Name: Michelle Caron
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The Wellness Roundtable Holistic Practitioners Network creates an environment for wellness practitioners to inspire, educate and support one another, while building community and encouraging...

Cost: $20 (Drop-ins are welcome)

Where:
Sohum Yoga and Meditation Studio
30 Lyman St
#108B
Westborough, MA
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Sponsor: 01581
Telephone: 508-329-3338
Contact Name: Ritu Kapur
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How would it feel to have direct education on changing your feelings so you do start to ask for what you truly want? Each month, come and practice hands-on skills to get into the habit of...

Cost: $15

Where:
Awaken Holistic Counseling Services
2 Liberty St., Unit 2L
Newburyport, MA  01950
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Sponsor: Awaken Holistic Counseling Services, LLC
Telephone: 978-255-7893
Contact Name: Kerri Morrison
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This is a class that will teach you how to make your own wire-wrapped gemstone pendant! Don’t be discouraged—it is simpler than you think, and you’ll have great fun in...

Cost: Reg includes supplies $40 per person or $35 more than one

Where:
The Healing Power of Flowers - Heaven and Earth
68 Stiles Rd
Unit A
Salem , NH  03079
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Sponsor: The Healing Power of Flowers - Heaven and Earth
Telephone: 603-275-7688
Contact Name: Stacey
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Retire the Curse, Enhance the Blessing with Sally Sugatt, LICSW, C-IAYT Do you feel locked into your family’s karma (reactions, cycles or patterns)? Come explore how you have been...

Cost: $45

Where:
YogaLife Institute of NH
6 Chestnut Street
Lower Level
Exeter, NH  03833
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Sponsor: YogaLife Institute of NH
Contact Name: Alice Bentley
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Award winning artist, musician and channeler, David Young shares his amazing revelations. Orchestrated synchronicities over the course of four years uncover the truth of what happened 2,000...

Cost: $35

Where:
Peaceful Creations LLC
382 Boston Turnpike
Suite 102
Shrewsbury, MA  01545
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Sponsor: Peaceful Creations
Telephone: 617-208-3333
Contact Name: Rebecca Resnik
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Facilitator: Peyton Pugmire Fridays, 9/20, 10/18, 11/15, 12/20, 9:30am–10:30am Everyone leaves with a powerful message to inspire their weekend!  Join Peyton Pugmire,...

Cost: Pay What You Wish

Where:
Creative Spirit
80 Washington Street
Marblehead, MA  01945
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Telephone: 781-797-0389
Contact Name: Creative Spirit
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Four week series for girls ages 11 and up with Leigh Sloss This series of classes will focus on some of the most effective yoga and mindfulness skills for reducing stress and anxiety.  In a...

Cost: Series: $75; Drop in rate $20

Where:
YogaLife Institute of NH
6 Chestnut Street
Lower Level
Exeter, NH  03833
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Sponsor: YogaLife Institute of NH
Contact Name: Alice Bentley
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Learn the facts about Lyme Disease and how to protect yourself and your family! The Central Mass Lyme Foundation will host its 4th Lyme Disease Conference....

Cost: In advance: $30, at the door: $40

Where:
Sturbridge Host Hotel & Conference Center
366 Main St.
Exit 9 off Mass Pike
Sturbridge, MA
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Sponsor: The Central Mass Lyme Foundation
Contact Name: Michele Miller
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With Ross J. Miller, psychic healer, medium, regression therapist. In this unique, experiential workshop you’ll learn how to identify your guardian angels and spirit guides by name and...

Where:
Newton, MA


Telephone: (617) 527-3583
Contact Name: Ross J. Miller
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Instructor: Peyton Pugmire Ages 16+/Adult Like meditating with a paintbrush!  Come re-connect with yourself, your heart and soul, and your divine intuition—one brushstroke...

Cost: $120 (includes all supplies)

Where:
Creative Spirit
80 Washington Street
Marblehead, MA  01945
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Telephone: 781-797-0389
Contact Name: Creative Spirit
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Practice what you have learned in Yoga for Plantar Fasciitis Part 1 (Nov. 2). Relieve pain on the bottom of the foot. It's not the usual stretching. It's a gentle way to...

Cost: $35 preregister; $40 at the door

Where:
Sohum Yoga and Medittaion Studio
30 Lyman Street
Suite 108b (next to hair salon)
Westborough, MA, MA  01581
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Sponsor: Pat Lebau Yoga
Telephone: 508-393-5581
Contact Name: Pat Lebau
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Journey back into the experience of peace, harmony and inner power through this unique meditation practice. Explore the power of your thoughts and how they can bring you inner harmony and help you...

Cost: Free of charge as a community service, contributions welcome.

Where:
Inner Space Meditation Center and Gallery
1110 Massachusetts Ave.
Cambridge, MA
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Sponsor: Brahma Kumaris
Telephone: 617–547–1110
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Reiki Master Teacher Libby Barnett, M.S.W., integrates her healing skills with past experience as a medical social worker at Massachusetts General Hospital. 38 years experience. Reiki...

Where:
Weston, MA


Telephone: 603-654-2787
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Psychics, mediums, angel readers, spirit art. Reiki, chair massage, IET, Gaiadon Heart, crystal healings, etc. Sign yourself up for a few appointments and bring your friends! Appointments...

Where:
Women of Wisdom
118 Washington Street
North Easton, MA
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Telephone: 508-230-3680
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Learn to overcome spinal tensions through therapeutic postures, designed to decompress your spine and relieve pain. Taught by a certified yoga therapist, classes bring you through poses...

Cost: 5/$50

Where:
Bliss Through Yoga
484 Bedford St
East Bridgewater, MA  02333
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Telephone: 508-331-3564
Contact Name: Janice O'Brien
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