Using the Lived Experience From Traditional Midwives in Remote Guatemala to Guide Improvement in Maternal Outcomes

Preeclampsia is the second leading cause of maternal death and accounts for 25% of infant deaths in Guatemala, where maternal and infant mortality rates are among the highest in Central America. One contributing factor is that most women give birth at home with traditional midwives (TMs) with limited reading and writing skills who lack training about obstetric emergencies, such as preeclampsia.

Guided by the World Health Organization's Quality of Care Theory of Change, authors conducted a qualitative study using thematic analysis of focus groups as the data collection method. The study was held in Spanish at 11 locations in the remote Petén department with 179 TMs to explore their knowledge, skills, and practices regarding preeclampsia. Audio recordings of the focus groups were transcribed verbatim and translated into English. Braun and Clark's thematic analysis was used to determine categories from focus group transcripts.

Six categories emerged: (1) knowledge of signs and symptoms, (2) awareness of risk factors, (3) expressions of maternal and fetal risks, (4) position for measuring blood pressure (BP), (5) differentiation between normal and abnormal BP readings, and (6) recognition of patient precautions during hospital transfers DISCUSSION: In remote communities, informal knowledge transfer and experience-based learning play important roles, even in the absence of formal training. This existing foundation provides an important basis for developing structured education programs and promoting greater integration of TMs into the health care system-specifically, to address issues associated with hospital transfer.