Gravity is the invisible midwife in indigenous birthing rituals, says Rosa Colta, a traditional midwife and intercultural health promoter in Otavalo, a town in the Andean highlands of Ecuador.
For that reason a maternity ward in the dimly lit hospital of San Luis de Otavalo calls to mind a small yoga or ballet studio.
Six horizontal bars covered in colorful rope hang on the back wall, forming a gradient, or "chakana," in Kichwa, the dialect of the Quechua language spoken here.
In a room right around the corner from the hospital's emergency room, laboring women move down the chakana's rungs during delivery, transitioning from almost standing before contractions, to kneeling with their palms on the lowest rung, back curled like a cat, posterior high and ready for birth.
The practitioners believe the downward abdominal pressure as a woman moves down the steps or switches from standing to squatting helps push the child out and speeds up dilation of her cervix.
Part of a model effort to lower maternal and infant mortality and attract more women to hospital deliveries, San Luis de Otavalo is the first public hospital in Ecuador to provide a so-called vertical maternity ward that connects indigenous birthing practices with access to modern medicine. The ward opened in April 2008.
"It was a hard fight for us to get into the hospital and care for women with our ancestral wisdom and practices, with our teas and waters, our sacred cleansing rites," says Colta. "Everyone has bad energy. But we shoo it out at birth."
I particularly enjoyed this gynecologist's commentary about vertical versus horizontal birth:
Pedro Luna, the chief gynecologist at the ward, attributes the speed of ... vertical deliveries to the use of a natural position. "Vertical birth-delivery, adapted by the Kichwa tradition, is a natural and instinctive process that makes physiological sense," says Luna. "Horizontal birth is an occidental practice brought by the conquistadors with zero medical logic."
First chosen mostly by indigenous women, vertical births are becoming more common among mestizas as well. Vertical births have also lowered the hospital's cesarean rate from 18% to 8%.