title: The changing role of indigenous lay midwives in Guatemala: new frameworks for analysis.
abstract: OBJECTIVE
  to examine the present-day knowledge formation and practice of indigenous Kaqchikel-speaking midwives, with special attention to their interactions with the Guatemalan medical community, training models, and allopathic knowledge in general.
  
  
  METHODS
  a qualitative study consisting of participant-observation in lay midwife training programs; in-depth interviews with 44 practicing indigenous midwives; and three focus groups with midwives of a local non-governmental organization.
  
  
  METHODS
  Kaqchikel Maya-speaking communities in the Guatemalan highlands.
  
  
  RESULTS
  the cumulative undermining effects of marginalization, cultural and linguistic barriers, and poorly designed training programs contribute to the failure of lay midwife-focused initiatives in Guatemala to improve maternal-child health outcomes. Furthermore, in contrast to prevailing assumptions, Kaqchikel Maya midwives integrate allopathic obstetrical knowledge into their practice at a high level.
  
  
  CONCLUSIONS
  as indigenous midwives in Guatemala will continue to provide a large fraction of the obstetrical services among rural populations for many years to come, maternal-child policy initiatives must take into account that: (1)Guatemalan midwife training programs can be significantly improved when instruction occurs in local languages, such as Kaqchikel, and (2)indigenous midwives' increasing allopathic repertoire may serve as a productive ground for synergistic collaborations between lay midwives and the allopathic medical community.
authors: Wuqu' Kawoq, 2 Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala.
authors: Anita
authors: A
authors: Chary
authors: Anne Kraemer
authors: AK
authors: Díaz
authors: Brent
authors: B
authors: Henderson
authors: Peter
authors: P
authors: Rohloff
mesh_terms: D000328:Adult; D005260:Female; D006166:Guatemala; D007722:Health Knowledge, Attitudes, Practice; D006303:Health Services, Indigenous / Q000592:standards*; D006801:Humans; D007400:Interprofessional Relations; D008427:Maternal Health Services / Q000592:standards*; D008875:Middle Aged; D008880:Midwifery / Q000193:education*; D009721:Nurse Midwives / Q000193:education* / Q000706:statistics & numerical data; D024382:Professional Role; D036301:Qualitative Research
keywords: Guatemala; Indigenous health; Lay midwifery; Traditional birth attendant