Simulation Learning Among Low Literacy Guatemalan Traditional Birth Attendants

Abstract

Guatemalan maternal and infant mortality rates remain high, particularly among indigenous populations. In remote areas, traditional birth attendants (TBAs), without formal midwifery education, are frequently the only maternal care providers. We conducted a mixed methods study to evaluate knowledge, skills, and attitudes of 26 TBAs in western Guatemala. The purposes of this study were to evaluate the efficacy of a community-based midwifery training program and to determine how the knowledge, skills, and attitudes of TBAs influence the care provided to indigenous mothers and infants. Themes from 5 key informant interviews included survival of mother and baby, facilitating referrals, and community pressure not to refer. We offered a 2-week simulation-based training designed for low resource settings. Participants completed pre- and posttests and demonstrated midwifery skills. Knowledge scores and objectively measured skills improved significantly. Attitude outcomes included increased endorsement regarding importance of pre- and postnatal visits, recognizing risk/complications, and partnering with medical providers. Potential effects discussed include safe TBA practice, training value, and intent to disseminate learnings in their communities.