To establish a community owned birthing center staffed by locals who speak the Mayan language, called a Casa Materna. The Casa Materna will be staffed at all times by skilled birthing attendants who speak the local Mayan language and who welcome the participation of the culturally preferred comadronas. The birth attendants are trained to identify high risk pregnancies and the Casa will provide transportation for high risk and emergency cases to the hospital 1.52 hours from San Juan.