PT - JOURNAL ARTICLE AU - Lievense, Breanne AU - Leach, Kaitlin AU - Modanlo, Nina AU - Stollak, Ira AU - Wallace, Jaqueline AU - Dominguez, Alma AU - Valdez, Juany AU - Valdez, Mario AU - Perry, Henry B. TI - Improving Maternity Care Where Home Births Are Still the Norm: Establishing Local Birthing Centers in Guatemala That Incorporate Traditional Midwives AID - 10.9745/GHSP-D-24-00057 DP - 2024 Sep 19 TA - Global Health: Science and Practice 4099 - http://www.ghspjournal.org/content/early/2024/09/18/GHSP-D-24-00057.short 4100 - http://www.ghspjournal.org/content/early/2024/09/18/GHSP-D-24-00057.full AB - Key FindingsMore than 50% of Indigenous women in Guatemala deliver at home, most often attended by comadronas, traditional midwives who are culturally important, preferred by women over health facilities, and serve as a viable alternative in many parts of the country where health facilities are not close nor easily accessible.Community-based and community-supported casas maternas (local birthing centers) provide a feasible alternative for women to give birth in a home-like setting that values comadronas’ involvement and cultural traditions in the birthing process and provide a place where trained health care providers can be present and rapid referral is available should a complication develop.Since their introduction in 2009, use of the casas has increased because of the enthusiastic support that comadronas have for them, strong appreciation from clients, and strong support of casa materna staff.Key ImplicationThis approach can be applied not only in Guatemala but also in areas throughout the world where home births predominate and can serve as an “interim” strategy for reducing maternal mortality until higher-level health care facilities become geographically, financially, and culturally accessible and acceptable to these underserved populations.More than half of births among Indigenous women in Guatemala are still being attended at home by providers with no formal training. We describe the incorporation of comadronas (traditional midwives) into casas maternas (birthing centers) in the rural highlands of western Guatemala. Although there was initial resistance to the casa, comadronas and clients have become increasingly enthusiastic about them. The casas provide the opportunity for comadronas to continue the cultural traditions of prayers, massages, and other practices that honor the vital spiritual dimension of childbirth close to home in a home-like environment with extended family support while at the same time providing a safer childbirth experience in which complications can be detected by trained personnel at the casa, managed locally, or promptly referred to a higher-level facility. Given the growing acceptance of this innovation in an environment in which geographical, financial, and cultural barriers to deliveries at higher-level facilities lead most women to deliver at home, casas maternas represent a feasible option for reducing the high level of maternal mortality in Guatemala.This article provides an update on the growing utilization of casas and provides new insights into the role of comadronas as birthing team members and enthusiastic promotors of casas maternas as a preferable alternative to home births. Through the end of 2023, these casas maternas had cared for 4,322 women giving birth. No maternal deaths occurred at a casa, but 4 died after referral.The Ministry of Health of Guatemala has recently adopted this approach and has begun to implement it in other rural areas where home births still predominate. This approach deserves consideration as a viable and feasible option for reducing maternal mortality throughout the world where home births are still common, while at the same time providing women with respectful and culturally appropriate care.