"Estas son las mañanitas, que cantaba Josue David" So begins the song "Las Mañanitias", which is sung at dawn for people on their birthday in Mexico and Central America. As it turns out, today was the birthday of both Josh and his baby that was delivered today during another capacitación. Father and child both celebrating a birthday and having a postpartum hemorrhage, all in one.
Today was another day of capacitaciones,a skills fair for midwives and nursing assistants. The government Ministry of Health requires each comadrona to attend 11 such training sessions in a given year in order to renew their registration card. Most of these are taught by nurses and staff from the various health clinics, but today's was taught by a group of six Americans and two Guatemalans from Casa Materna.
We left from Arnoldo and Abesaida's house around 8 and arrived a half-hour later in Chiantla which is a smaller town on the outskirts of Huehue. We were met by about 25 comadronas from Chiantla and neighboring towns. Almost all spoke Spanish (which was a major improvement in communication), although there were a few that spoke primarily Mam. Our jobs were quite similar from two days prior: Melissa teaching shoulder dystocia, Rosalicia and Mariah teaching postpartum hemorrhage, Chris doing neonatal resuscitation, Josh teaching emergency breech delivery, Suzy talking about the birth kits, Paulina (from Casa Materna) talking about nutrition, and Yasmin (also from Casa Materna) teaching emergency signs in pregnancy.
After the talk we had a chance to chat as a group, and the comadronas were very appreciative of the manual skills and knowledge they were able to practice during the session. They also made a point of singing a very special "Happy Birthday" to Josh.
After lunch we repeated most of the same stations with nursing assistants from the local Puestos de Salud and CAPs. Most did not have a ton of obstetrical experience, but were also quite appreciative of the training. 
One very encouraging development in recent days is that it seems like our efforts to make misoprostol available to comadronas in distant communities is beginning to pay off. As mentioned previously, the law prevents this medication from being dispensed by non physicians. In towns that are as many as 6 hours from the hospital by car, and have only a Puesto de Salud (which haven't been permitted to stock Misoprostol), it appears the departmental health officials are moving towards making misoprostol available to the Puestos who can give it to the patient en route to the hospital. This is not a done deal, but it is enormously important in the effort to decrease maternal deaths.
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