Thursday, June 16, 2011

Birthing Options in Guatemala City: An Interview with Hannah Freiwald

I had a "normal, healthy" hospital birth with my first child, so you may wonder why I have chosen to use a midwife here in Guatemala City instead of the hospital option.

While I don't consider hospital births evil, and I'm not bashing doctors, I do think people use them with a different mindset. When I go to a hospital, I am surrounded by people used to looking for the worst case scenario. This is what saves many people's lives. However, if you have that mindset for birth, something the body is made to do naturally- not an illness, it's no wonder that many precautionary hospital practices have lead to an extremely high Cesarean section rate in the United States... and in Guatemala. I am glad these interventions exist and am thankful for the many lives they have saved, but in most cases I don't think it is the best mindset to start with.

Looking back, it was a miracle that I wasn't pushed into a C-section at the last minute like so many hospital births are. I was very overweight. The doctor's visit that I initially went in for ended in the hospital a week before my due date because the "baby wasn't moving enough." I later found out that the reason for that was because I was in the initial stages of labor. I was hooked up to a blood pressure monitor all night, which painfully took my blood pressure every 30 minutes- effectively removing my ability to sleep the night before giving birth. Exhausted, the next morning they started me on Pitocen which began to speed up the little bit of labor I had left, since my body had almost completely stopped contracting on its own. The doctor then broke my water as the nurse kept upping the amount of Pitocen going into my system. The shock and pain of all of these things happening at once, though I didn't want one, had me asking for an epidural. This was the first time I was able to sleep in 36 hours. This rest allowed my body the time and resources it needed to hurriedly get ready enough, though everything was still so rushed. Nurses came in every two hours to check my cervix. I prayed the whole time that my body would just cooperate and I wouldn't have to get a C-section.

I'll finish this part of the story just by saying that I did give birth to a healthy little girl. I was so exhausted and disconnected from what had happened that it didn't even seem real. I couldn't bond with my baby. I couldn't nurse. This only spiraled into a postpartum depression that got worse. I fought depression and pumped for four months trying to learn how to nurse before we finally figured it out. There is nothing I have faced worse than my baby screaming because she was hungry, and I was there ready to feed her, but we couldn't figure out how.

For every physical stretch mark that I have from birth, there is a mental one as well. I hated losing control over my own body. Do I hate doctors? No. Do I think my doctor did the right thing? No. I think she did what she was trained to do to avoid complications, to avoid lawsuits, to "deliver" me from myself... but I couldn't help feeling that birth was more instinctual and that it shouldn't be like the experience I had. I know many people think I should've just been happy that I had a "normal" delivery with a healthy baby as a result. Please don't get me wrong, I appreciated those things, but I didn't want to do it again. There had to be another option. This lead me to research my options in Guatemala City; the place we are now located, pregnant with our second child.

The C-section rates in Guatemala are horrible (as high as 70%) in many hospitals. I asked around in the expat community looking for any other option and, thankfully, discovered Hannah Freiwald, the only English-speaking (she also speaks German and Spanish) midwife in the capital. Also the only midwife with her own birth clinic. Thankfully, for me, another option. I still can't believe the difference in care, just in the prenatal spectrum, from my first experience. I don't feel like "just another patient." I'm not saying my first doctor was a bad person, but the clinical environment made every part of the process feel like I was just another patient with a possible problem that could become apparent at any moment. With my first pregnancy it felt like the unspoken rule was "ask no questions and do what I tell you to do." Hannah is different. The environment is different. The approach is different. The end goal is different. I'm still learning how to ask and not be scared. I'm still learning how to be in control of my own body.

I'm not the only person like this. Many people in Guatemala have had much, much worse hospital experiences than I have. I am grateful that mine went so well. Women who can't afford care who go to public hospitals are not allowed to have family in the room with them. They labor in a room full of other women who are laboring and then, when high blood pressure becomes an issue (can you imagine it not being an issue in that situation?!) They are forced into C-sections with no family available and no second opinions possible. Many, many of these women have also found Hannah. Many of these women still face the initial hurdle of not being able to afford care... and Hannah helps them anyhow. Her clinic that helps mostly indigenous and low income Guatemalan women called "Manos Abiertas" (Open Hands) works on a sliding pay scale. This often means patients visit free of charge or pay much less than their visit costs, because most can't afford the $5 for a checkup. Still, Manos Abiertas, has to have money to survive. One of the programs they have started to help with this is the sponsor-a-birth program where people can help women like Maria Bernarda. (Pictured below.)

Here is an excerpt of an interview with Hannah explaining some of the challenges of birth, midwifery and funding in Guatemala:

What birthing options are available for Guatemalans?

•"For poor Guatemalans, there are the national hospitals: C-section rates are getting close to 50%, all kinds of other interventions are routine, and the woman is unaccompanied through her birth."
•"The IGGS, the social security hospital, is very similar."
•"Many people who can barely afford it therefore opt for one of the small private clinics, only to have the same experience but paying for it."
•"Aprofam, an organization that started out subsidized but has to be sustainable at this point, has taken the same route in order to sustain itself."
•"In the rural areas there are local midwives available, some of which are very experienced and well (mostly self-) trained, while others are not."
•"The big hospitals in the city have a C-section rate of 70 to 80%, besides being very expensive."

"In zone 11 we are facing the problem that people do not have a concept of a natural birth anymore - we have lost clients because they lost patience. People are so used to getting their babies cut out of them or pulled out of them or being hooked up to an IV that they do not believe in letting birth progressing normally. The urban clientele on one hand is used to getting things fixed "now" and on the other hand has no education to reason for themselves.
The c-section rate in Guatemala is shocking, and seems to largely come from doctors being in a hurry (lots of patients!) and having inadequate training in obstetric techniques. They also get more money for performing a c-section than a vaginal delivery (as is the case in the US as well.)"

How is what you offer with Manos Abiertas different?
"It is unfortunate that respectful, empowering, and patient-based care is not the norm, but it is clear that when women find it they will not settle for anything less. Patients came to Manos Abiertas from across the country, taking 3 and 4 hour bus trips to seek care. Patients told stories of other clinics they had visited, where they never received results, where procedures and medications were not explained, where their birth control was unreliable and suddenly unavailable, and where they were c-sectioned unnecessarily. Low income Guatemalan women have not yet grasped that they deserve respect. Teaching them this fact is a big part of our work."
"Manos Abiertas offers something different, and it is clear that it is needed. One of the most extraordinary things about Manos Abiertas is the home-birth atmosphere that they are able to offer to their clients. Women labor and birth in a quiet, comfortable, homey environment, surrounded by their family and friends (and sometimes half of the village.) They are able to deliver naturally, and usually go home to their family the next day. The new baby is celebrated and fussed over by the clinic staff, and the mom is at the center of all of the action."

I don't know how you feel about the midwife vs. hospital birth issue, and I welcome your dissent if you disagree with me, but if nothing else let's agree that no matter one's social status, they should have an option. The ability to have control over one's own body is a basic right. If that right is given away freely, that's one thing, but the ability to have a choice is necessary. Without funding, Centro de Parto Natural and Manos Abiertas wouldn't be able to offer the Guatemalan indigenous women, the ones who are constantly refused the rights to their own bodies on a daily basis, the ability to choose their own manner of birth. Please consider donating.

Spanish educational material about birth approx. 60$ or 470Q
1 professional grade, waterproof fetal doppler: $125 or 985Q plus shipping
1 complete birth package 240$ or 1,884Q

Also on their wish list is an obstetric ultrasound machine. Any donation, no matter the size, will help make a difference in a woman's life.

Thank you, from me, from countless women who would tell you if they could. Thank you.

Read the rest of the interview here.


  1. Thankyou Adina for drawing my attention to this blog. It's beautifully written and very worth while.
    I have copied your message into the Australian Private Midwives Association blog

    You will see that I am calling for midwives in the developed world to accept our responsiblity for the high (and rising) rate of Caesarean births in our countries. Midwifery is the only profession that has access to the knowledge and skill of working in harmony with the natural processes in birth. Women who choose natural birth are very likely to 'fail' unless they have a maternity care provider who values and understands the natural physiological processes in birth and parenting.

    Best regards
    Joy Johnston

  2. I too have published your message on my blog Adina! Thank you for your advocacy for women in your part of the world. How wonderful it is that so many people care about women and birth. Together, we are all making a difference. I hope the messages get through to people and everyone gives a little something to help your clinic help more women. I've read the information about Hannah, she sounds wonderful, and I'm delighted to be able to contribute to her work. Blessings to all, Carolyn

  3. The C-section rate in Chile is also extremely high. Actually, I think once that I read that it has the highest c-section rate in the world, though I'm not sure if I would believe that as Chilean newspapers seem to exaggerate the facts sometimes.

    But when I asked a friend who works in a hospital about that she said that, A. C-sections are what women in Chile are used to and want (umm, don't know about that). And B. It's a good way for the hospital to make more money. Not surprising really. After all is said and done, health care in most places is another profit machine.

  4. I had a fantastic experience with Hannah. I had my first born son with her and she really made it a great experience. Read my story here:

  5. Enjoy having your babies naturally :) that´s nature, that´s God!!
    She´s my mom!! And im having my second baby girl in water :D