By Dominique Soguel
Sunday, February 15, 2009
As part of a national effort to lower infant and maternal mortality in Ecuador, one hospital runs a "vertical maternity ward" with upright deliveries and the services of traditional midwives. Amid growing popularity, other hospitals are following suit.
OTAVALO, Ecuador (WOMENSENEWS)--Gravity is the invisible midwife in indigenous birthing rituals, says Rosa Colta, a traditional midwife and intercultural health promoter in Otavalo, a town in the Andean highlands of Ecuador.
For that reason a maternity ward in the dimly lit hospital of San Luis de Otavalo calls to mind a small yoga or ballet studio.
Six horizontal bars covered in colorful rope hang on the back wall, forming a gradient, or "chakana," in Kichwa, the dialect of the Quechua language spoken here.
In a room right around the corner from the hospital's emergency room, laboring women move down the chakana's rungs during delivery, transitioning from almost standing before contractions, to kneeling with their palms on the lowest rung, back curled like a cat, posterior high and ready for birth.
The practitioners believe the downward abdominal pressure as a woman moves down the steps or switches from standing to squatting helps push the child out and speeds up dilation of her cervix.
Part of a model effort to lower maternal and infant mortality and attract more women to hospital deliveries, San Luis de Otavalo is the first public hospital in Ecuador to provide a so-called vertical maternity ward that connects indigenous birthing practices with access to modern medicine. The ward opened in April 2008.
"It was a hard fight for us to get into the hospital and care for women with our ancestral wisdom and practices, with our teas and waters, our sacred cleansing rites," says Colta. "Everyone has bad energy. But we shoo it out at birth."
In this small room, shelves spill over with herbs ranging from "patacun yuyo," a mountain weed that they believe reduces abdominal pain, to "hojas de higo," fig leaves used to clean and numb the vaginal area during birth and to enhance muscular activity.
Three traditional midwives take turns concocting teas and washing waters for the mother, who starts to ingest these special infusions when the cervix reaches a dilation of three to four inches.
Midwives here massage and bathe the mother until the baby is born. A "yatchak"--literally "he who knows"--oversees the spiritual dimension of this process and ensures it follows ancestral cosmic laws. This Andean shaman welcomes the child into the world beating five stones on the door frame--representing the fingers of a hand--in the maternity ward.
"Every detail of the delivery is important to us," said yatchak Huillka Pukara Pakhsi, a name that means "moon force" in Kichwa. "It is a road map revealing the child's nature, foreshadowing its life. This hospital room becomes a sacred place, an altar, because this is where life begins."
The hospital has a team of six obstetricians, three interns, eight nurses, one gynecologist and 10 traditional midwives trained in vertical delivery.
Five to six babies arrive a day in accordance to ancient Kichwa lore in this medical setting.
The hospital continues to provide modern horizontal birthing care in an adjacent room but the demand for vertical births is growing.
From April to December 2008, the hospital hosted 128 vertical deliveries. In January alone, there were 68, more than half of overall deliveries.
"Vertical birth is quicker, easier," said Monica Pasmayo, as her husband wheeled her out of the hospital with a tiny newborn nestled in her arms earlier this month. "The baby comes out and you are free to go."
Five years ago, Pasmayo gave birth horizontally to her first daughter, Maria Fernanda. Labor lasted six hours then. Delivering a boy vertically on Feb. 5 took her half the time.
Pedro Luna, the chief gynecologist at the ward, attributes the speed of Pasmayo's delivery and other vertical deliveries to the use of a natural position.
"Vertical birth-delivery, adapted by the Kichwa tradition, is a natural and instinctive process that makes physiological sense," says Luna. "Horizontal birth is an occidental practice brought by the conquistadors with zero medical logic."
When the hospital opened the intercultural maternity ward, says Luna, indigenous women accounted for 95 percent of vertical deliveries. Most mestizas--women of mixed racial heritage--preferred horizontal, occidental delivery. The ratio is now 56 percent indigenous and 44 percent mestiza.
The hospital has an infant mortality of 7.8 per 1,000 live births, less than half the national average, which stands at 19 per 1,000. The vertical maternity ward witnessed one maternal death due to complications from an unrelated membrane infection, compared to eight deaths due to complications in horizontal deliveries the previous year.
Vertical deliveries, says Luna, have also helped reduce Caesarean sections from 18 to 8 percent at the hospital.
The hospital's successes have turned it into a model for a nation that is trying to reduce maternal mortality and neonatal fatalities by 30 to 35 percent. In January, the maternity ward became a training center for clinics hoping to introduce or master this ancestral practice.
Luna says he is working on an agreement with national universities and the health ministry to teach ancestral practices at the medical school. There are 40 trained traditional midwives who work in Otavalo and surrounding rural areas tending to a population of 102,000.
The Ministry of Health called for an accelerated national strategy in August 2008 to reduce maternal and neonatal fatalities. The training of traditional midwives and the creation of intercultural, vertical maternity wards were incorporated in the government's strategy. So far, intercultural maternity centers that incorporate vertical birthing practices have spread from Otavalo to the provinces of Chimborazo, Amazonia and Esmeraldas.
The United Nations Population Fund for Women supports Hospital San Luis de Otavalo's center as a way to help meet the millennium development goal of reduced maternal mortality by making hospitals friendlier to rural communities that follow traditional customs.
Lily Rodriguez, an assistant representative at the United Nations Population Fund in Ecuador, says the introduction of the ward increased deliveries in hospitals by 8.3 percent.
"We figured out that the majority of indigenous and mestizas delivered babies at home because they were afraid of the hospital," says Rodriguez. "They didn't understand the technical language. They were uncomfortable with the request to undress. They missed their teas and families."
Dominique Soguel is Women's eNews Arabic editor.
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