In our earlier blog about the Jambu Huasi clinic we wrote about some of the traditional medicine practiced by the local Yachacs (shamans), Parteras (lay midwives), and Fregadoras (medical masseuses). We promised to give an update after we completed our month in Otavalo. Since we wrote that first blog, Lena and I had the chance to spend a few days on the labor and delivery unit in the local hospital. (I want to report that even though it has been 14 years since I quit practicing obstetrics, I am pleased to confirm that babies still come out the same way, and I surprisingly haven’t forgotten very much about it.)

The triage of the L&D is very similar to the triage area of any L&D that
I have worked in. Laboring patients come in and are placed on a fetal heart monitor and an internal exam is performed by an Obstetrician (a trained midwife, not a MD). If the woman is in labor and the tracing is okay, she is brought to a labor room. In contrast to the triage room, the labor room is markedly different from any I have ever seen. The room is designed to appear as if it were a traditional Quechua house. The room is made entirely of wood with a fire place (non-working), and a working stove. There is a hospital bed, but it pushed inconspicuously to the side and isn’t used until after delivery. Hidden discreetly in a corner is an incubator and oxygen. During labor, the patient is attended to by the Partera. If the Partera deems it necessary, she will perpare herbal treatments on the stove or will perform a limpia (cleansing). The Partera almost constantly massages the patients- to help with the pain (somewhat gentle) as well as to “open up the pelvis” –not gentle at all! There are no epidurals and there are no pain meds. There are no IVs, there is no additional fetal monitoring (what a pleasure it would be to have practiced obstetrics without constant monitoring), and there are no additional internal exams as long as it seems as if the labor is progressing (no labor curves here my friends!). The Partera watches for cues from the laboring woman such as the amount she is sweating and her desire to bare down to determine that the patient is in the second stage of labor (10cm dilated and ready to push). During the second stage, the woman pushes while she squats and holds onto one of three horizontal bars mounted to the wall or holds onto a knotted rope hanging from the ceiling while she is squatting. She delivers while she is on all fours or while sitting on a semi-circular chair placed underneath the rope that is hanging from the ceiling. The husband is told to blow on his wife’s head to help breath life into the baby. The Partera does the delivery unless there are minor complications and then the obstetrician (who is nearby) steps in and repairs any lacerations. The cord is not clamped until there is no longer any pulse in the cord. The placenta is placed in a plastic bag (a grocery bag brought by the husband) and it is taken home and planted (not eaten). If there are any significant complications such as a post-partum hemorrhage or retained placenta, there is an adjacent OR and a gynecologist (an MD) is in the hospital at all times (they do have oxytocin, methergine, and Cytotec for PP hemorrhage). In general, the deliveries we saw were very fast (even for the primips) and were very calm. We even saw a baby born in the caul. In addition, the elective repeat scheduled C-section that we watched was done very well. So what are my takes on all of this?

1. The biggest take home message is that the traditions of the indigenous Quechua culture are respected and in so doing, the vast majority of deliveries are now occurring in the hospital. According to the staff at the hospital and at Jambu Huasi, this is huge change in the past decade and has resulted is a very significant decrease in infant and maternal mortality. (They couldn’t give me exact numbers.)
2. In most deliveries, the adage “less is more” holds true. We certainly witnessed this. Fewer interventions = less complications. Their C-section rate is less than 10%.
3. We didn’t witness any significant complications but I know very well that there can always be an unforeseen and potentially catastrophic complication. Therefore, it is still my opinion that all deliveries should occur in a hospital with access to appropriate medication, blood bank, and anesthesia.
4. I (Andrew) will never give birth to a baby, but it seems much more natural and easier to do it while squatting without an epidural. (The women in my family disagree with this!)
5. Oh yeah, it certainly helps that all the babies we saw were less than 7.5 pounds- it helps to have small babies- though the women we saw were small themselves.
6. I (Lena) loved the whole experience (even loved watching the c-section) and fell in love with the babies, but I’m not a huge fan of the placentas.