Study for training of traditional midwives in Chocó, Colombia

Midwifery continues to be a traditional practice widely used in Colombian departments where barriers to access to health services make it necessary to care for pregnant women in the communities.

In Chocó, one of the departments with the highest percentage of population dispersed in areas far from urban centers, lack of health institutions, difficulties in access to health care due to lack of roads, high transportation costs and frequent affectations to the civilian population due to the armed conflict, this practice prevails today in 60% of deliveries.

Sinergias conducted a qualitative study in the rural area of Quibdó (Chocó) to understand the practices and beliefs of midwives and birth attendants regarding maternal health care and newborn care. Based on this research, a validated training proposal was developed, adapted to the local needs and knowledge of community health workers.

Traditional midwifery in Colombia

Despite the Colombian State's attempts to increase the coverage of institutional care in pregnancy and childbirth, there are records in the country that confirm that traditional midwives attend about 30% of the births that occur in marginalized urban and rural areas.

Midwives are the best allies to save the lives of women and newborns because they represent community bonds by understanding and sharing cultural patterns related to pregnancy, childbirth and postpartum care. They also generate a series of practices that, from their worldview, protect the life of the pregnant woman and the newborn.

Evidence shows that quality midwifery services, coordinated and integrated with communities and the health system, can ensure continuity of essential care throughout pregnancy, childbirth and postpartum. High-quality midwifery care for women contributes to healthy families and more productive communities.

Results: What do midwives think?

In the research, midwives and birth attendants stated that they have received little training from health institutions and that there are occasional clashes with professionals because they do not agree with traditional midwifery and attribute poor maternal and neonatal morbidity and mortality figures to this practice. However, in some areas they work hand in hand.

In addition, the community's relationship with this practice is satisfactory: the midwives and midwives are in contact with the pregnant women from the beginning of the pregnancy and through visits they observe their general appearance and state of health. They also use natural remedies to alleviate pain or discomfort associated with pregnancy, listen attentively to them and advise them based on their experience.

Midwives with nursing assistant training were also found to have a broader spectrum of knowledge in infection risk reduction practices, pregnancy physiology, and management of complications with medications.

Some recommendations that have arisen

• The diverse characteristics of midwives in terms of their level of knowledge, cultural practices and access to certain resources, makes the possibility of a single, general educational strategy more complex, requiring the support of different pedagogical tools.

  
  

• There are important gaps in the knowledge of midwives, so it is important to develop a continuous training process to improve their knowledge.

  
  

• High visual impact educational material should be developed, with graphics that represent local phenotypes so that they feel identified and can remember the key actions or relevant decisions to take in the event of an emergency.

  
  

• Alliances should be established for joint work with health institutions, enhancing the role of midwives as key agents at the community level. Referral and counter-referral systems should also be improved to strengthen the health system's response.

Last but not least, this research called on the government, headed by the Ministry of Health, to provide support and a political framework for the definition and regulation of midwifery practice in Colombia, to manage the standardization of its work through training programs, and to allocate the necessary resources for this purpose.

Thanks to this research, Sinergias developed a pilot experience to strengthen the technical capacities of the midwives of Quibdó, based on the recognition of their own and the adaptation of the most relevant western practices in this context.