Objective: To explore conceptions of obstetric emergency care among traditional birth attendants in rural Guatemala, elucidating social and cultural factors.
Study: design Qualitative in-depth interview study.
Setting: Rural Guatemala.
Sample: Thirteen traditional birth attendants from 11 villages around San Miguel Ixtahuacán, Guatemala.
Method: Interviews with semi-structured, thematic, open-ended questions. Interview topics were: traditional birth attendants' experiences and conceptions as to the causes of complications, attitudes towards hospital care and referral of obstetric complications.
Main outcome measures: Conceptions of obstetric complications, hospital referrals and maternal mortality among traditional birth attendants.
Results: Pregnant women rather than traditional birth attendants appear to make the decision on how to handle a complication, based on moralistically and fatalistically influenced thoughts about the nature of complications, in combination with a fear of caesarean section, maltreatment and discrimination at a hospital level. There is a discrepancy between what traditional birth attendants consider appropriate in cases of complications, and the actions they implement to handle them.
Conclusion: Parameters in the referral system, such as logistics and socio-economic factors, are sometimes subordinated to cultural values by the target group. To have an impact on maternal mortality, bilateral culture-sensitive education should be included in maternal health programs.