Manuela had become pregnant as a teenager. This alone was a source of shame to her, because she was a practicing Catholic and believed that premarital sex was a sin. She compounded her sin by having an illegal abortion. She did it because she had been certain that if her parents found out she was pregnant, they would be terribly disappointed in her.
When she married in her twenties, she was too ashamed of the sin the abortion represented to her to tell her husband about it. They tried for several years, but had difficulty conceiving a child. Manuela was convinced that God was punishing her for having had the abortion. She felt harmful to her husband because her punishment was now hurting him as well, and she was lying to him by not telling him it was all her fault.
She eventually conceived and had a difficult pregnancy and dangerous childbirth in which she almost died. She took this hardship as proof that she had to pay dearly to make up for her sinfulness.
She had been burdened with her sense of sinfulness, of separation from God, for thirty years.