Her baby was coming, and Milagros Vásquez, 20, needed help.
With a mini-dress stretched over her swollen and increasingly stressed body, Vásquez braved a motorbike journey across three rivers and gripped her belly through two jolting bus rides. But arriving at the first hospital was just the beginning.
Over the course of 40 hours, Vásquez, a former high school sports star, visited a second hospital, a third, a fourth. We have no sterile tools, they told her at one. No incubator, they said at another.
She took another bus. She slept on a bench. She cried in the street, losing count of the number of doctors who had placed their hands inside her, measuring her body’s dilation, only to tell her to leave.
She tried a fifth hospital. We can’t help you, they said.
Finally, in Caracas, the capital, she stood outside the largest maternity ward in the country and sent up a last, desperate plea.
“Please God,” Vásquez prayed, “please don’t let me die.”
Venezuela’s public health system, once the best in Latin America, has been in a state of progressive collapse for years, crippled by a broken economy overseen by an increasingly authoritarian government. But few parts of that system have been as damaged as its maternity wards, where the most critical birthing tools — vital sign monitors, ventilators, sanitation systems — have broken down or just disappeared, sometimes forcing doctors to turn women away.
About half of the country’s physicians, some 30,000 people, have left in recent years, many of them desperate to save their own families, according to the Venezuelan Medical Federation.
The true effect of this on mothers and babies is unknown. The most recent data come from 2016, when maternal deaths shot up by 65% and infant mortality rose by 30% in a single year. The minister who published that information was promptly fired — and new statistics have been treated as a state secret since.
To understand what it is like to give birth in this shattered system, we followed pregnant women to six hospitals in Venezuela, and one across the border in Colombia, as they sought to deliver.
To give birth in Venezuela today is to risk death — for both the woman and her child.
Vásquez was once a high school handball player so celebrated for her strength and skill that she traveled Latin America representing Venezuela.
But one day this January, on the doorstep of a towering Caracas hospital, Concepción Palacios, she crumpled, sobbing, her arms around the waist of her mother, Cristina, who pounded on the door, begging for her daughter to be admitted.
Vásquez fainted. But then the door opened, and about 48 hours after her labor pains began, she gave birth to baby Cristal. But her infant, born premature and tiny at just 3.3 pounds, didn’t make it past morning.
Days later, Vásquez pulled a white baby blanket from the pocket of her sweatshirt, one of her only memories of her daughter.
Hospital officials had declined to give her a death certificate, and with no money for a burial, she had to leave Cristal’s body in the morgue.
“Here,” she said, “a woman is treated like a dog.”
For many Venezuelan women today, the defining feature of childbirth is the ruleta, or roulette: The grueling process of traveling from hospital to hospital, trying to find one that is equipped to help them.
They sometimes hitchhike, or walk for miles, or take buses over roads whose ruts and bumps seem designed just to torture them. In rare cases, they are rejected over and over until finally giving birth in the street, on a hospital’s steps — or in its lobby.
“I threw myself on the ground,” said Evaró Chacín, 32, who said her daughter was born on the lobby floor at Hospital Noriega Trigo in Maracaibo after staff there told her they couldn’t take her. “It was my husband who had to help me.”
In some instances, women die. Darwin Maiquetía, 37, lost his wife, Kenny Chirinos, on Jan. 20, after she developed an infection following a cesarean section in a military hospital. For years, hospitals have struggled to acquire disinfectant.
“The level of anger I have is not normal,” said Maiquetía, cradling his newborn daughter, Alena, one afternoon. He chose a military hospital, he said, because he thought that in an increasingly militarized country, it would be safe.
Chirinos, an avid outdoorswoman who often went rappelling on the outskirts of Caracas with her husband, was the love of his life, he said.
“They’re destroying families,” he said, “destroying lives.”
In his many televised speeches, the country’s president, Nicolás Maduro, has characterized the country’s health system as facing challenges but generally doing well. As recently as March, he encouraged women to “give birth, give birth,” saying that every woman “should have six children” for the good of the country.
He has attributed the country’s medical supply shortage to sanctions, which President Donald Trump has imposed to try to push Maduro out.
Analysts and critics claim this assertion has only some weight.
Sanctions have sometimes delayed the delivery of essentials, but the government could go through aid organizations to get what it needs, said Feliciano Reyna, founder of Venezuelan nonprofit Action for Solidarity.
One economist, Asdrúbal Oliveros, said Maduro had simply chosen to prioritize the import of oil and food over medicine, making the calculation that pregnant women and sick people don’t protest — but that hungry people do.
The heads of the country’s women’s ministry and health ministry did not respond to requests for interviews. Nor did the directors at several major hospitals.
Years into the country’s recession, a growing number of expectant mothers are grappling with crisis-related problems — like malnutrition — that heighten the risk of a complicated birth and the need for expert help.
The obstetricians and pediatricians who remain have found it nearly impossible to do their work.
Inside the delivery room at the public hospital in the city of La Victoria, Nataly Smith, 21, climbed onto a metal birthing bed one night, shaking and alone. She wore pink lipstick and had her hair in a ponytail. Blood pooled on the floor below her.