Although the traditional birth attendant (TBA) is the major provider of health care for women in Guatemala, she receives little recognition or support from the Guatemalan health care system. This study explores the midwifery practices of TBA”s among the Mayan population in Guatemala”s highlands, where infant and maternal mortality rates rank among the highest in Latin America, and assesses the TBA training programs being implemented by the Ministry of Health and by private and international agencies. The training programs have had a positive influence on some harmful traditional practices (e.g., the use of alcohol by TBA”s and their laboring patients, encouraging women to push too early in labor) and have introduced beneficial new procedures (e.g., washing hands, screening and referring high-risk patients, providing nutrition counseling). Unfortunately, three positive traditional practices have been vigorously discouraged by trainers — the upright delivery position, external version in the case of malpresentation of the fetus, and cauterization of the umbilical cord. Training has also failed to discourage the widespread but highly dangerous use of oxytocics to hasten the process of labor. The study concludes that despite the existence of several exciting and innovative programs, the training courses in general are using inappropriate and ineffective materials, and are trying to apply a western, urban, hospital-based birthing model to TBA training. A list of recommendations is provided concerning how midwifery practice could best be supported or modified to enable it to make a maximum contribution to maternal and child health.
