Culturally adapted flowcharts in obstetric emergencies: a participatory action research study.

INTRODUCTION: Maternal mortality is a health problem in developing countries and is the result of several factors such as sociodemographic and economic inequalities and difficulties in accessing the health services. In addition, training strategies in obstetric emergencies targeting the non-medical personnel such as traditional midwives are scarce. The focus of this study is to develop learning and communication bridges on the management of obstetric emergencies and on policies of patients' referral to the biomedical health system in rural areas. METHODOLOGY: A Participant Action Research (PAR) study with a mixed methods approach was set up to elaborate culturally adapted flowcharts. The project lasted approximately 3,5 years, from September 2016 to January 2021. RESULTS: The study was conducted with 94 traditional midwives from southern Ecuador and is divided into 4 phases, namely: 1) Exploration: focus groups and interviews were conducted to document the management of obstetric emergencies through the presentation of "clinical case" scenarios in three important topics, namely: pre-eclampsia, shoulder dystocia and postpartum hemorrhage, 2) Planning: a number of reflective sessions were conducted between the researchers and the healers/midwives to elaborate flowcharts. 3) Action: the training was conducted in rooms dedicated to proficiency in the aforementioned topics and using the flowcharts, 4) Evaluation: 90% of the participants reported having used the flowcharts during the first year after the training. The most frequently used flowchart was that of pre-eclampsia for the recognition of warning signs during pregnancy control. CONCLUSION: This study documents common practices of pregnancy and delivery management by traditional midwives. Furthermore, cultural flowcharts were developed for and together with midwives to improve the clinical response to obstetric emergencies. The preliminary evaluation was favorable; the most frequently used flowchart concerned preeclampsia. In this process, establishing a partnership was crucial for successful intercultural collaboration.

Integrating Traditional Midwives into the State Health System: A Critical Case Study from Chiapas, Mexico.

Efforts to integrate traditional midwives into state health systems have not succeeded in reducing perinatal mortality, but have nevertheless continued in many countries, including Mexico. The authors used ethnographic methods to examine an NGO's efforts to integrate traditional midwives into the state health system in the Sierra Madre region of Chiapas, Mexico. We found that most of the traditional midwives in the study area have little to gain by such integration, and ask whether it is possible, practical, and ethical to integrate traditional midwives into health institutions until and unless such policy is grounded in local realities.

Saberes ancestrales y tradicionales en parteras de la parroquia cañar. Un instrumento para su medición / Ancestral and traditional knowledge in midwives of the cañar parish. An instrument for your measurement

Las parteras tradicionales son mujeres que aprenden de forma generacional habilidades para atender un parto natural desde la medicina natural. Sin embargo, estas prácticas carecen de atención al momento de alguna complicación tanto para el bebé como para la Objetivo: validar los instrumentos cuantitativo y cualitativo que nos permitirán Identificar los saberes ancestrales y tradicionales en parteras de la parroquia cañar en periodo junio 2020, a junio 2021. Materiales y métodos: Investigación mixta: cuantitativa y cualitativa. De tipo de campo, de corte transversal de tipo evaluativo, de diseño no experimental. La población está constituida por 20 parteras de parroquia Cañar, con edades de 25 a 75 años. Resultados: El instrumento cualitativo arrojo un promedio de confiabilidad total de sus tres categorías de 89,8 lo que coloca en la categoría de muy confiable y en el instrumento cuantitativo se obtuvo un promedio de confiabilidad de 91,2 lo que señala que se encuentra ubicado dentro de la categoría de muy confiable. Conclusión: Los resultados evidencian que los instrumentos son aptos, confiables y válidos para medir la variable independiente, y su correlación con la variable dependiente, cumplimiento de la hipótesis general de esta investigación(AU)

Traditional midwives are women who learn, generationally, skills to attend a natural birth from natural medicine. However, these practices lack attention at the time of any complication for both the baby and the mother Objective: to validate the quantitative and qualitative instruments that will allow us to identify the ancestral and traditional knowledge in midwives of the Cañar parish in the period June 2020, to June 2021. Materials and methods: Mixed research: quantitative and qualitative. Field-type, cross-sectional, evaluative, non-experimental design. The population is made up of 20 midwives from the Cañar parish, aged between 25 and 75 years. Results: The qualitative instrument showed an average of total reliability of its three categories of 89.8, which places it in the category of very reliable and in the quantitative instrument an average reliability of 91.2 was obtained, which indicates that it is located in the very reliable category. Conclusion: The results show that the instruments are suitable, reliable and valid to measure the independent variable, and its correlation with the dependent variable, fulfilling the general hypothesis of this research(AU)

Birthing Between the "Traditional" and the "Modern": DaI Practices and Childbearing Women's Choices During COVID-19 in Pakistan.

Pregnancy and birth are biological phenomena that carry heavy cultural overlays, and pregnant and birthing women need care and attention during both ordinary and extraordinary times. Most Pakistani pregnant women now go to doctors and hospitals for their perinatal care. Yet traditional community midwives, called DaI in the singular and Dayun in the plural, still attend 24% of all Pakistani births, primarily in rural areas. In this article, via data collected from 16 interviews-5 with Dayun and 11 with mothers, we explore a maternity care system in tension between the past and the present, the DaI and the doctor. We ask, what does the maternity care provided by the Dayun look like during times of normalcy, and how does it differ during COVID-19? We look at the roles the DaI has traditionally performed and how these roles have been changing, both in ordinary and in Covidian circumstances. Presenting the words of the Dayun we interviewed, all from Pakistan's Sindh Province, we demonstrate their practices and show that these have not changed during this present pandemic, as these Dayun, like many others in Sindh Province, do not believe that COVID-19 is real-or are at least suspect that it is not. To contextualize the Dayun, we also briefly present local mother's perceptions of the Dayun in their regions, which vary between extremely positive and extremely negative. Employing the theoretical frameworks of "authoritative knowledge" and of critical medical anthropology, we highlight the dominance of "modern" biomedicine over "traditional" healthcare systems and its effects on the Dayun and their roles within their communities. Positioning this article within Pakistan's national profile, we propose formally training and institutionalizing the Dayun in order to alleviate the overwhelming burdens that pandemics-present and future-place on this country's fragile maternity care system, to give mothers more-and more viable-options at all times, and to counterbalance the rising tide of biomedical hegemony over pregnancy and birth.

Access to Maternal Health Services During the COVID-19 Pandemic: Experiences of Indigent Mothers and Health Care Providers in Kilifi County, Kenya.

COVID-19 has spread rapidly in Kenya and has not spared pregnant women. Evidence from Kenya shows that during the COVID-19 pandemic, health systems have been either stressed to their maximum capacity or are becoming overwhelmed. However, the population is advised not to attend hospital unless strictly necessary, and this advice seems to apply to all, including expectant mothers. There is a dearth of information on how poor expectant mothers with low bargaining power cope during COVID-19 in Kenya, which this study addresses for those in Kilifi County. This rapid qualitative study draws data from an extensive literature review and from interviews with 12 purposively selected mothers who were either expectant or had newborn babies during the pandemic in Kilifi County. Five matrons-in-charge of maternal health services and four traditional birth attendants were also interviewed via mobile phone. Data were analyzed thematically and are presented in a textual description. It emerged that expectant mothers feared attending hospitals for perinatal care due to the possibility of contracting COVID-19. Therefore, there was an increase in home deliveries with the assistance of traditional birth attendants (TBAs)/traditional midwives, who were also overwhelmed with women who sought their services. Since most causes of maternal morbidity and mortality can be prevented by prompt, suitable treatment by qualified health practitioners, the health officials interviewed recommended training and integration of TBAs in emergency healthcare responses to help during crises in MHS because they are trusted by their local communities. Notably, such integration of traditional midwives should be supported and should also include additional training and monetary incentives.

O dom e a dádiva entre parteiras do Amapá: uma abordagem etnográfica / The dom and gift among midwives from Amapá: an ethnographic approach

Resumo Este artigo trata das visões de mundo e práticas das parteiras tradicionais que moram em Santana (AP, Brasil). Tendo como base pesquisa de campo de caráter etnográfico e entrevistas semiestruturadas, apresentamos o entendimento dessas mulheres acerca do seu ofício, destacando a centralidade desempenhada pelas noções nativas de dom e de divino nesse universo. Também apresentamos e interpretamos a dimensão simbólica das relações estabelecidas entre essas mulheres, as parturientes e a entidade nomeada por elas como Deus. Neste contexto, observamos que as obrigações relacionadas aos endividamentos não compulsórios no dar-receber-retribuir, apontado na maioria dos estudos sobre parteiras, não se restringem à relação entre família da parturiente e parteira. Na concepção local, as relações relevantes de obrigação concatenadas ao dom para o ofício se estabelecem entre humanos e Deus. Grosso modo, a contradádiva é efetivada no atendimento às gestantes, mas como uma espécie de obrigação diante de Deus. Assim, o atendimento às mulheres que procuram as parteiras é entendido como o meio adequado de saldar a dívida adquirida com o ser divino.

Abstract This article studies the world conceptions and practices of traditional midwives who live and work in Santana (Amapá, Brazil). Based on an ethnographic fieldwork including semi-structured interviews, we present how these women perceive their craft, highlighting the centrality of the category dom and the notion of divine in this universe. We also discuss the symbolic dimension of the relationships established between the midwives, the pregnant women and the entity known by them as God. In this regard, the obligations associated to the non-compulsory debts in the giving, receiving and returning cycle, pointed out by most studies on traditional midwives, are not restricted to the relation between the patient's family and the midwife. According to the local conception, the most relevant relations of obligation associated to the dom for their craft are those established between humans and God. The counter-gift is accomplished through patient care, but as a sort of obligation towards God. Assisting the women who seek midwives is, thus, understood as the adequate means to settle the debt with this divine entity.

Safe Birth and Cultural Safety in southern Mexico: study protocol for a randomised controlled trial.

BACKGROUND: Indigenous women in the southern Mexican state of Guerrero face poor maternal health outcomes. Living as they do at the very periphery of the Western health system, they often receive low-quality care from health services that lack human and financial resources. Traditional health systems remain active in indigenous communities where traditional midwives accompany women through motherhood. Several interventions have explored training birth attendants in Western birthing skills, but little research has focussed on supporting traditional midwives by recognising their knowledge. This trial supports traditional midwifery in four indigenous groups and measures its impact on maternal health outcomes. METHODS: The study includes four indigenous populations in the State of Guerrero (Nahua, Na savi/Mixteco, Me'phaa/Tlapaneco and Nancue ñomndaa/Amuzgo), covering approximately 8000 households. A parallel-group cluster-randomised controlled trial will compare communities receiving usual care with communities where traditional midwives received support in addition to the usual care. The intervention was defined in collaboration with participants in a 2012 pilot study. Supported midwives will receive a small stipend, a scholarship to train one apprentice, and support from an intercultural broker to deal with Western health personnel; additionally, the health staff in the intervention municipalities will participate in workshops to improve understanding and attitudes towards authentic traditional midwives. A baseline and a final survey will measure changes in birth and pregnancy complications (primary outcomes), and changes in gender violence, access to healthcare, and engagement with traditional cultural activities (secondary outcomes). The project has ethical approval from the participating communities and the Universidad Autónoma de Guerrero. DISCUSSION: Indigenous women at the periphery of Western health services do not benefit fully from the attenuated services which erode their own healthcare traditions. Western health service providers in indigenous communities often ignore traditional knowledge and resources, inadvertently or in ignorance, disrespecting indigenous cultures. Improved understanding between midwives and the official healthcare system can contribute to more appropriate referral of high-risk cases, improving the use of scarce resources while lowering costs of healthcare for indigenous families. TRIAL REGISTRATION: ISRCTN12397283 . Retrospectively registered on 6 December 2016.

La partería tradicional / Traditional midwifery

RESUMEN Introducción: Las parteras tradicionales apoyan en la atención del parto humanizado, lo cual les permite a las mujeres en trabajo de parto controlar la situación y tomar sus propias decisiones. Objetivo: Describir las prácticas de la partería tradicional en tres regiones del Departamento del Magdalena, Colombia. Métodos: Estudio descriptivo transversal, enfoque cuantitativo, desarrollado con 15 parteras de los municipios de Santa Marta, Ariguaní y Fundación, departamento del Magdalena, los datos fueron recolectados utilizando un cuestionario estructurado y validado, aplicado en el primer semestre de 2016. La muestra fue tomada a conveniencia, dado al nivel de accesibilidad de las investigadoras con las parteras se pudo obtener 5 parteras de cada población, para un total de 15. Los datos cuantitativos fueron analizados utilizando estadística descriptiva (distribución porcentual y media). Resultados: El 54 por ciento se encontraba entre los 50 y 80 años de edad, vivían en zona rural 80 por ciento, tenían entre 30 y 60 años de experiencia como parteras 53 por ciento, todas son mujeres (100 por ciento) y sabían leer y escribir, 93 por ciento hablaba español, solo el 7 por ciento hablaba la lengua nativa, 47 por ciento aprendió a atender partos por tradición familiar, el 25 por ciento aprendió sola, el 20 por ciento aprendió a atender partos por medio de otra persona y el 8 por ciento aprendió por medio de un curso de capacitación. Conclusión: La partería en esta región continúa transfiriéndose de generación en generación, teniendo prácticas tradicionales como el uso de tomas después de la atención del parto(AU)

ABSTRACT Introduction: Traditional midwives support humanized delivery, which allows women in labor to control the situation and make their own decisions. Objective: To describe the practices of traditional midwifery in three regions of Magdalena Department, Colombia. Methods: Cross-sectional descriptive study, with a quantitative approach, developed with 15 midwives from the municipalities of Santa Marta, Ariguaní, and Fundación, Magdalena Department. The data were collected using a structured and validated questionnaire, applied in the first semester of 2016. The sample was taken at convenience, given the researchers' level of accessibility with the midwives. Five midwives from each population could be obtained, for a total of 15. The quantitative data were analyzed using descriptive statistics (percentage and average distribution). Results: 54 percent were at age 50-80 years, 80 percent lived in rural areas, 53 percent had 30-60 years of experience as midwives, all are women (100 percent) and knew how to read and write, 93 percent spoke Spanish, only 7 percent spoke the native language, 47 percent learned how to assist births by family tradition, 25 percent learned by themselves, 20 percent learned how to assist births through another person, and 8 percent learned by means of a training course. Conclusion: Midwifery in this region continues to be transferred from generation to generation, having traditional practices, such as the use of intakes after delivery care(AU)

Indigenous Healing Knowledge and Infertility in Indonesia: Learning about Cultural Safety from Sasak Midwives.

In this article I demonstrate what can be learned from the indigenous healing knowledge and practices of traditional Sasak midwives on Lombok island in eastern Indonesia. I focus on the treatment of infertility, contrasting the differential experiences of Sasak women when they consult traditional midwives and biomedical doctors. Women's and midwives' perspectives provide critical insight into how cultural safety is both constituted and compromised in the context of reproductive health care. Core components of cultural safety embedded in the practices of traditional midwives include the treatment of women as embodied subjects rather than objectified bodies, and privileging physical contact as a healing modality. Cultural safety also encompasses respect for women's privacy and bodily dignity, as well as two-way and narrative communication styles. Local understandings of cultural safety have great potential to improve the routine practices of doctors, particularly in relation to doctor-patient communication and protocols for conducting pelvic exams.

Ejercicio tradicional de la partería frente a su profesionalización: estudio de caso en Jalisco, México / The traditional practice of midwifery and its professionalization: a case study in Jalisco, México / Exercício tradicional do partejo frente a sua profissionalização: estudo de caso em Jalisco, México

RESUMEN Objetivo: analizar el estado de la partería en Jalisco, México, frente al proceso de profesionalización. Metodología: Estudio de caso, realizado desde junio de 2011 a julio de 2013 en tres momentos: I. Entrevistas a profundidad con 20 parteras, II. Cuatro asambleas regionales con 44 parteras, III. Una asamblea estatal con 136 parteras, personal de salud y otros actores sociales, retomando técnicas educativas populares. Los datos cualitativos fueron analizados bajo el modelo actancial semiótico y los datos sociodemográficos de parteras en Epi Info 7, realizando una meta-inferencia con ambos hallazgos. Resultados: 180 parteras informantes, 89% de zona rural, media de edad 56 años, 73% con estudios de secundaria o menos, 95% son parteras tradicionales, adoptando esta práctica desde la adolescencia, capacitándose en instituciones de salud y entre las mismas parteras; 16.7% estudiaron enfermería buscando posicionamiento institucional, sin dejar de ser parteras. Actualmente otorgan atención materno-infantil y a nosologías tradicionales, aludiendo abandono institucional. Existen posturas de rechazo y aceptación de su incorporación al sector salud en médicos y enfermeras, mientras que otros actores sociales, piden su reconocimiento. Conclusiones: la partería en Jalisco, México, es una práctica tradicional vital, con o sin reconocimiento institucional, transformándose en respuesta a necesidades de atención, teniendo que considerar el perfil sociodemográfico de las parteras, su papel actual, la perspectiva del personal de salud y otros actores sociales, junto con la estrecha relación sociocultural y económica del país, frente a su profesionalización.

ABSTRACT Objective: to analyze the status of midwifery in Jalisco, Mexico and its professionalization process. Methodology: a case study conducted from June 2011 to July 2013 in three stages: I. in-depth interviews with 20 midwives, II. four regional assemblies with 44 midwives, and III. a state assembly with 136 midwives, health care staff and other social actors. The three stages employed popular educational techniques. In addition, qualitative data were analyzed using the actantial semiotic model, and the midwives' sociodemographic data were processed in Epi Info 7. Finally, a meta-inference was performed with the findings from both datasets. Results: a total of 180 midwives participated in the study, 89% of which operate in rural areas. The average age was 56, and 73% of the midwives had secondary education or less. Moreover, 95% of them were traditional midwives who adopted this practice since their adolescence and received training from health care providing institutions and from other midwives. In addition, 16.7% studied nursing in order to obtain positions in institutions while remaining midwives. They currently provide care for mothers and children as well as for patients with traditional nosologies. They also mention that they suffer institutional neglect. Among doctors and nurses, there are positions of rejection and acceptance regarding their inclusion in the health sector, while other social actors request their acknowledgement. Conclusions: midwifery in Jalisco, Mexico, is a traditional and vital practice with or without institutional recognition. It is an answer to the need for health care. Likewise, it is necessary to consider the socio-demographic profile of midwives, their current role, the views of the health care staff and other social actors and the close cultural and economic relationship of the Country regarding its professionalization.

RESUMO Objetivo: analisar o estado do partejamento em Jalisco, México, frente ao processo de profissionalização. Métodos: Estudo de caso, realizado desde junho 2011 ao julho 2013 em três momentos: I. Entrevistas em profundidade com 20 parteiras, II. Quatro assembleias regionais com 44 parteiras, III. Uma assembléia estadual com 136 parteiras, funcionários da saúde e outros atores sociais, na retomada das técnicas educacionais populares. Os dados qualitativos foram analisados sob o padrão actancial semiótico e os dados sociais demográficos de parteiras em Epi Info 7, realizando uma meta-inferência com ambos achados. Resultados: 180 parteiras informantes, 89% de zona rural, media de idade 56 anos, 73% com estudos da secundaria ou menos, 95% são parteiras tradicionais, adotando esta prática desde a adolescência, capacitando-se em instituições de saúde e entre as mesmas parteiras; 16.7% estudaram enfermagem procurando posicionamento institucional, sem deixar de ser parteiras. Atualmente outorgam atenção materno-infantil e as nosologías tradicionais, aludindo abandono institucional. Existem posições de rejeito e aceitação da sua incorporação ao setor saúde nos médicos e enfermeiras, entanto que outros atores sociais, pedem o seu reconhecimento. Conclusões: O partejo em Jalisco, México, é uma prática tradicional vital, com ou sem reconhecimento institucional, transformando-se em resposta as necessidades de atenção, tendo que considerar o perfil social demográfico das parteiras, o seu papel atual, a perspectiva dos funcionários da saúde e outros atores sociais, junto com a estreita relação sociocultural e financeira do país, frente a sua profissionalização.

Entre la necesidad y la fe: la partera tradicional en el Valle del río Cimitarra / Between the necessity and the faith: the traditional midwives of the Valley of the Cimitarra river

Este artículo pretende analizar las características de las parteras tradicionales en la región del Valle del río Cimitarra en el Magdalena Medio colombiano a la luz de su contexto ambiental. Así, se realiza un acercamiento al contexto de la apartada región rural y de las características de las siete parteras tradicionales que participaron en el estudio. Lo anterior, asumiendo la postura teórica de Leininger de comprender las creencias y prácticas culturales inmersas en un contexto ambiental particular. Se evidencia cómo las características de las parteras tradicionales son el resultado de su adverso contexto social, económico y político de esta compleja región; y así mismo, cómo la necesidad de cuidar la vida determinó las razones que las impulsaron a hacer de la partería parte de su quehacer, sustentándolo en la fe a diferentes divinidades.

This article analyzes the characteristics of traditional midwives in the Valley of Cimitarra river of colombian Magdalena-Medio region in relation to their environmental context. This approach was used to describe the situation on the remote rural region, and the essential features of the seven midwives who participated in the study. This study assumes the Leininger's theoretical viewpoint to understand the cultural beliefs and practices embedded in particular ambiance. This article support how the characteristics of traditional midwives are the result of its adverse social, economic and political adverse context within this complex region, and likewise, how the need to take care of life determined the reasons that led the midwifery to become part of their duty, supporting it in faith to different deities.

As representações sociais das parteiras tradicionais e o seu modo de cuidar / The social representations of traditional midwives and their way to care

Este artigo discute, com base na Sociologia das Ausências e Emergências de Boaventura de Souza Santos, as representações sociais do saber/fazer das parteiras tradicionais. Busca salientar a necessidade de diálogo entre os diferentes saberes e sinaliza que a educação popular pode contribuir para uma ecologia de saberes e para a prática educativa dos profissionais de saúde.