Pakarii Casa de Nacimiento (Pakarii Birth Home), the first birth center in Peru, was opened in Lima in 1995 with the purpose of promoting and expanding the philosophy of natural birth and waterbirth. In the Andean native language Quechua, Pakarii means “dawn, coming out to the light, starting something new, being born.” Pakarii was founded by Angela Brocker, a German surgeon trained in Peru and Mexico. Brocker was fascinated by the wisdom of Andean traditional midwifery and she envisioned a humanized model of birth care that would articulate some of the Andean techniques that she had learned along with modern obstetrical knowledge. She worked directly with Fernando Cabieses, a renowned Mexican-Peruvian neurosurgeon and researcher, at the former Instituto de Medicina Tradicional (now the Center of Intercultural Health of Peru, CENSI) to forge a maternal health program which combined both modern obstetrics and ancestral midwifery.
Pakarii’s work has been very important in reintroducing natural birth and homebirth in Peruvian mainstream culture and media, including the important role of doulas for birthing women. Pakarii has appeared numerous times in national television. The founder’s training as a surgeon has helped to rebuild trust in a model of care which had become foreign to recent generations of women in the urban capital. Pakarii has also greatly contributed to the education of obstetricians (a term meaning trained, but non-physician, birth attendants in Peru). Pakarii introduced the use of waterbaths and started the first school for doulas in Peru. Since 2006, more than 180 doulas have attended the program.
Pakarii provides pre-natal and post-natal education and offers both homebirth and birth home delivery services. Women and their families are accompanied with a holistic, woman-centered model of care. Births are attended mainly by Brocker with the support of Pakarii’s team of obstetricians and doulas. Breastfeeding workshops as well as women’s wellbeing holistic workshops are also offered to support women’s health throughout the life cycle. Most workshops are taught by the Pakarii team while personalized consultations are provided by Broker.
Two decades of respectful, professional care provided by the Pakarii team has forged a new culture around birth in Peru. The C-section rate of transferred women is 9% and there have been no maternal deaths during an experience with 800 births. Pakarii Casa de Nacimiento in Lima is showing that care at a birth home can be a natural and safe option for many women today.
Noteworthy Good Birth Practices
- Pakarii has managed to develop an appropriate model of birth attention in Peru which articulates Andean midwifery legacy and modern obstetrics.
- Holistic accompanying approach throughout the whole process around birth to mother and couples, with a strong spiritual component, especially to accompany traumatic outcomes and grieving processes (whatever didn’t happen as desired, eg as in a c-section)
- Freedom of movement and birth positions for the laboring woman, freedom in decision-making process, respect for the couple’s expression (non-judging) during labor.
- The umbilical cord is cut only after the birth of the placenta. Mother/baby and father/baby skin-to-skin contact is encouraged, together with immediate breastfeeding after birth.
- Baby’s height and weight are only measured after 2 or more hours after birth.
- Home visits are conducted after birth when necessary, both for mother and baby care.
- Pakarii has reintroduced in the capital city a more personal and horizontal model of care in the health services and consultations provided to women. Check-ups last minimum 1 hour and home visits are offered when needed, including for baby’s consultations.
- Location: Lima, Peru
- Established: 1995
- Staffing: 1 doctor-midwife, obstetrician (on-call when needed), doulas (on-call); support staff (OB/GYNs)
4-9 deliveries per month
60-100 clinic visits per month (including home consultations)
9% Cesarian section rate
Home visits, “Informative nights” (on natural birth, every Thursday), Women’s health education programs
Doula training program
Public hospitals: Essalud and Instituto Nacional Materno Perinatal (ex-Maternidad de Lima)
Private clinics: Hogar de la Madre, Clínica Good Hope, Clínica Delgado, et al
Examples of respected local practices and knowledge
- An Andean cloth is tied around a high wooden beam, from where the birthing woman can pull down to help her transit through rushes (contractions).
- The placenta is given to the mother/ couple.
- Placenta ceremonies are offered for the new families at Pakarii to burry their placentas in the Andean traditional way and to “close” in this way the experience of the birth itself.
Cynthia Ingar, 2016