Casas Maternas, in English known as Maternity Homes, are widely used throughout Nicaragua. Nicaraguan women developed these Maternity Homes in 1985 in response to the high maternal mortality rates throughout Nicaragua.
Nicaragua has the highest maternal mortality rates in all of Central America. To provide a comparison, 1 in every 50 pregnant women die due to complications in Nicaragua, compared to 1 in every 3,000 in developed countries. That’s a huge difference!
Most of the pregnant women who die due to complications live in rural areas, hours from a medical clinic or hospital. For example, the hospital for the entire Municipality of Nueva Guinea is located in the city of Nueva Guinea. However, out of the 135,000 residents in the Municipality, only 35,000 live in the city, meaning that 100,000 live in the rural areas, far away from a medical facility!
Most maternal deaths are due to preeclampsia, infections, hemorrhaging, miscarriages, and the retention of placenta. These deaths are preventable!
Therefore, Maternity Homes were established for the use of these rural dwelling women.
How it works:
- There are 29 health posts located throughout the Municipality of Nueva Guinea. Each health post consists of one MD and one nurse. There are 32 colonies and 66 communities within those colonies and each is assigned to a particular health post. At times, the Dr. or nurse will go on visitas de terreno (house calls), but the majority of the time residents need to find their way to their health post. Even though the health posts are much closer than the hospital, for some it can still be a two-hour trip. At week 36 or there about, the Dr. sends the pregnant women to the city to a casa materna.
- The women find their own way to a casa materna. Here in Nueva Guinea, we have three! That is exceptional. Most urban areas have one, and some have yet to have one established. Between all three, about 60 women can be accommodated. The Nicaraguan Ministry of Health (MINSA) funded casa materna recently opened. Here’s an article (in Spanish) about the inauguration of the facility: (click here).
- Since the women typically spend a month at the casa materna, some of them bring a friend, sister, cousin, or mother along with them. However, the casa materna will not provide amenities to their companion. Often times, the companion end up sleeping on the floor. More often than not, the women come alone. This can be a very hard time for them. They know no one, have nothing to do but watch telenovelas (soap operas), and often find themselves to be very lonely and bored. We have also been told that women do not like coming to the casa maternas for fear that their partner will find another women while they are gone for a month. This does occur!
- The casa maternas that are not run by MINSA may charge a one-time fee of 20 cordobas, less than $1. The MINSA facilities are completely free. While at the casa maternas, the women are provided with a bed, bathroom facility, and food with use of the kitchen. Since there are not a lot of financial resources, the food typically consists of rice, beans, and tortillas. Unfortunately, it is a rare occurrence to have meat, vegetables, or fruit available for the women.
- Each casa materna has a full time partera (midwife) who watches over the women 24/7. In case of any emergency, a taxi is called to take the women to the hospital. The taxis are much more reliable and time efficient, as there is nothing like 911 in Nicaragua. If one is lucky to get the assistance of the ambulance, they are often asked to provide the money for the gas! However, all the care provided at the MINSA hospital is completely free, no matter what casa materna one comes from. Government run medical services have no charge throughout all of Nicaragua.
- Each casa materna also has a daily visit from a Dr. to check on the women and also the newborns. That’s right! I neglected to say that the casas maternas are also used as a recovery space once the mother gives birth.
- MINSA has been charged with the responsibility of providing weekly charlas (informational talks) to the pregnant women. Since many come from rural areas, they arrive with lack of information, misinformation, belief in myths, and at times even harmful practices for baby and mom passed down from previous generations. This is where we come in!
-Tim and I provide weekly charlas to each casa materna. That means that currently each casa receives two charlas per week. We discuss topics such as family planning, breastfeeding, nutrition, what to expect during the birth process, what danger signs to watch for, how to tell the baby is coming, etc. They are all fairly basic, but not necessarily for these women. Yesterday, I did a charla on breastfeeding and all the women were convinced that one cannot give breast milk to the baby after cooking because the milk will be too warm for the baby.
So, where do we go from here?
We are not planning on giving weekly charlas for two years. It’s not sustainable and it just doesn’t make sense!
Our long-term plan is to develop a manual of about 15 charlas and train the parteras on how to give daily charlas to the pregnant women in the casas maternas. These charlas will include fun ways of divulging and reviewing the information with the women. The tricky part is that most of the parteras and pregnant women are illiterate.
Therefore, I am currently working on a literacy program for the parteras. It will be a two-month course and we’re going to provide a diploma of completion at the end along with a little party. My counterpart at MINSA loves this idea and has shown incredible support such as providing a facility and covering the cost of lunch for all participants. So cool! We are aiming for the course to start in September. - Caressa