A draft of the WHO Global Strategic Directions for Nursing and Midwifery (World Health Organization [WHO], 2021) was made available for review April 1, 2021, with comments invited. This evidence-based document focuses on four strategic directions: education, leadership, jobs, and service delivery. One of the key policy priorities of service delivery is to enable midwives and nurses to maximally contribute to service delivery environments (WHO). A grassroots initiative, the Humanitize Expeditions Community Midwife Project exemplifies this priority. It began when a Guatemalan traditional village midwife (comadrona) came into a health clinic in Los Robles, San Andres Semetaba, Guatemala in 2013, asking for a box of exam gloves for her village practice attending births of indigenous Guatemalan women. These needs were the basis of a partnership between community midwives and the Humanitize Expeditions Community Midwife Project that includes Utah nurse midwife and family nurse practitioner Susan Chasson.

In 2014, a conference was held with comadronas using the American Academy of Pediatrics Helping Babies Breath curriculum (Callister, 2016). Each midwife was provided with a bag of supplies (sterile cord clamps, gloves, newborn clothes, and a neonatal Ambu bag). Yearly the team gives each midwife a larger donated item in addition to infant clothes, gloves, and cord clamps; for example, basic dopplers, watches to time contractions, and pregnancy wheels translated into Spanish. Other requested items include baby scales, blood pressure cuffs, and stethoscopes. Education and supplies were provided annually since 2014 until the global COVID-19 global pandemic when the Guatemalan international airport was closed for an extended period. In May 2021, classes were held separately with midwives from six communities because of the pandemic. As the team currently only intervenes yearly, it is difficult to assess the impact of the initiative on the quality of midwifery services delivery such as morbidity and mortality. However, recent work has documented potential reduction of maternal and neonatal mortality with midwifery care globally (Nove et al., 2021).

In a classic ethnographic study of the meaning of childbearing to Guatemalan women, study participants identified the sacred nature of childbirth, the need for reliance on God during childbearing, and the bittersweet paradox of giving birth (Callister & Vega, 1998). It is essential to recognize and respect the important role of comadrona's traditions and knowledge as they frequently care for indigenous Guatemala childbearing women in underserved areas of the country and share their spiritual perspectives of giving birth. As many comadronas speak only a native Mayan dialect (Kiche or Kaqchikel) instead of Spanish, the team matches them with a native speaker. The midwives have received basic training from the Guatemalan Health Ministry, but when asked how they became a midwife, they share that God came to them in a dream and gave them the skills and knowledge.

In Guatemala, the 2020 national maternal mortality rate was 73 per 100,000 live births (Every Mother Counts, 2021). The mortality rate is more than double among indigenous women living in poor and isolated communities. The 2020 neonatal death rate in Guatemala was 12.2 deaths per 1,000 live births. Nearly 50% of Guatemalan's population are indigenous Mayans, with 54% living in poverty and 13% living in extreme poverty, many in rural and poor communities often located hours from health care facilities. Indigenous women often seek care from village midwives (Every Mother Counts). These experiences are significantly different than most women giving birth in the United States. Review the WHO (2021) document on nurses' and midwives' roles in health care to get a current view on global health nursing and the contributions of nurses in other areas of the world.

References