Pregnancy
Conditions
Keywords
Prenatal care, Maternal mortality, Perinatal mortality, Perinatal, Puerperium, Puerperium care, Midwives, Midwife, Obstetric, Nurse, Integration, Alternative personnel, Skilled attendant, Birth attendant, Delivery, Delivery services, Best practices, Rural
Brief summary
Rates and causes of maternal mortality in Mexico have dropped only slightly; thus, reaching the internationally established Millennium Development Milestones (MDM) is still a distant goal. A fundamental part of reducing maternal and infant mortality is ensuring skilled attendance during pregnancy and delivery. This project uses an innovative strategy of integrating professional midwives and licensed obstetric nurses into rural medical centers in the states of Guerrero and Oaxaca, Mexico, to provide prenatal care, delivery services, and puerperium care. The goal of the research is to increase use of best practices in intake, labor, delivery, and puerperium care; decrease the use of unnecessary or harmful care; and improve maternal and neonatal outcomes. We posited that medical centers receiving the intervention would provide better care and have better maternal and neonatal outcomes than those that did not receive the intervention.
Interventions
OTHERPM/ON integration
Professional midwives or obstetric nurses are integrated into clinic staff and delivering services.
Sponsors
Mexican National Institute for Women
Mexican Center for Gender Equity and Reproductive Health
Secretary of Health, Guerrero state
Secretary of Health, Oaxaca state
Instituto Nacional de Salud Publica, Mexico
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Outcomes Assessor)
Eligibility
Healthy volunteers
No
Inclusion criteria
* Clinics containing one medical team only (1 doctor and accompanying staff) * Clinics less than 2 hours away from a referral hospital * Clinics where at least 25 deliveries took place in the previous year
Exclusion criteria
* Clinics inaccessible by car * Clinics undergoing remodeling
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Use of evidence-based practices during labor, delivery, and postpartum care | 21 months | Will collect data on deliveries ocurring in sites over 21 month period. |
| volume of prenatal visits, deliveries | 21 months | We will Assess overall number of first and follow up prenatal visits and deliveries in intervention and control sites |
| Use of harmful or unnecessary practices during labor and delivery | 21 months | We will assess use of harmful or unnecessary practices during labor and delivery |
Outcome results
None listed