I wish I'd known enough about birth to ask more and better questions when I was in the Peace Corps in Paraguay. I do know that they had a tradition of always having two older women at a birth. These women did not call themselves midwives, just "women who help other women." A midwife usually was only called for when there was a problem, like when the sun rose a second time on a laboring woman. The problem was that "calling for the midwife" meant sending a child on a horse some 10 miles away to the midwife's home, where he may or may not find her home. That woman, though a lay midwife, had also gone through a government training program and had a license to get pitocin, antibiotics and some other medications. She was very respected by the women in the region, while the health "professionals" - the nurses at the local health post - held her in contempt. There was just one motorized vehicle - a motorcycle - in the entire village - and the "hospital" (a rather abysmal place similar to what was described in Haiti) was nearly 20 miles away over rutted dirt roads that washed out in even moderate rain.
The government was doing a big campaign to try to get women to not birth at home, to go to the hospital instead. Many younger women from more modern/well-off families did this, but giving birth at home still was the norm. The routine cutting of large episiotomies was a major factor keeping women at home. When asked why they wouldn't go to the hospital, women would tighten their faces and say, in a low voice, "They cut you there." But doctors and nurses had been taught this was a requirement for a safe birth, especially in a primip.
I remember two births in one family that was very opposed to modern medicine and very dedicated to traditional remedies and healing. The daughter-in-law, just 14, was pregnant with her first child. That girl's mother was the sister of a well-known and respected midwife and called herself a midwife as well. But the other women didn't trust her and whispered about the bad outcomes of women and babies she had attended. She insisted on being the sole attendant at her daughter's birth, which turned out to be long and difficult, going on 48 hours. The mother-in-law gathered several other women and started fighting with the mother over what to do, how the birth was going, etc. The other women believed the baby was in a bad position, while the mother (of the laboring girl) insisted it wasn't. She finally allowed someone else to get involved when the mother-in-law threatened to bring her husband into the room. They did some sort of manipulation and the baby was born shortly afterward.
That story haunts me - I can't imagine being 14 years old, in the far-gone mental state of such a long labor, with all the women I trust to guide me through the process fighting with each other over my labor.
As far as I could tell, though, both mother and baby came through it okay.
A few months later, the daughter of that same family was ready to give birth to her first child. The family was shook up by the most recent experience, and she decided to go to the health post a few miles away (not the big hospital in town). As she stood out by the side of the road at 4:30 in the morning waiting for the bus, she decided her contractions were getting too strong and close together to take a ride and went back home. A few hours later, after just five or six hours of total labor, this very petite girl birthed a 9 lb. baby with no complications. I saw her a few hours later, resting happily in her own bed with the most alert newborn I've ever seen.
I'll tell just one more story - of a young woman who decided to go to town and wait at a cousin's house to go into labor so she could birth at the hospital. I don't know anything about her labor or birth, but I shared a seat with her on the bus two days after the birth as she tried to return home. It had rained and the bus stopped two miles out from our village because there was a steep hill down, across a precarious bridge and then up again to get to our village, and the bus couldn't make it in the mud. She had to walk those two miles with her baby with a still-raw episiotomy. She showed it to me a few days later - she was in agony, worried it was infected and wanted my opinion (no, I'm not a medical professional of any sort). It was a huge mediolateral episiotomy - almost two inches - and she had been shaved, too. That as my glimpse into hospital birth in Paraguay.
