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Guatemalan lay midwives are on the front lines of a crisis. The Maternal Mortality Rate (MMR) in Guatemala is 65th highest in the world at 120 deaths per 1,000 births. Part of the problems is not lay midwives attend the majority of births despite lacking knowledge about obstetrical emergencies. Government training programs established in 1955 have not changed lay midwives' knowledge, partially due to culturally insensitively. Government training programs are taught in Spanish with written material, even though most lay midwives are illiterate and speak Mayan dialects. The purpose of this mixed methods study was threefold: to explore lay midwives' knowledge, attitudes and practices about obstetrical emergencies, to evaluate the effect of a culturally sensitive oral teaching in the native language on lay midwives' knowledge of obstetrical emergencies, and to determine if lay midwives retained knowledge from a past, culturally sensitive oral teaching in the native. language about postpartum hemorrhage (PPH).
During two weeks in September 2016, 191 lay midwives from more than 30 villages participated in 11 trainings throughout the remote Peten. A one-group pretest posttest design was used for the quantitative evaluation. Focus groups were used for the qualitative evaluation. The Long Table Approach was used to develop a matrix of common themes from focus groups. A checklist from the American College of Nurse Midwives (ACNM) was used to evaluate knowledge of obstetrical emergencies and of PPH before and after the teaching. Results indicated lay midwives retained knowledge about obstetrical emergencies immediately after the culturally sensitive teaching, but not about PPH eight years later. Focus groups themes revealed lay midwives lack education, equipment, support and transportation for addressing obstetrical emergencies. Future teachings should use a similar format to address the needs of illiterate participants in resource-poor settings and should retest participants within a year
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