Wuqu' Kawoq | Maya Health Alliance 2 Calle 5-43, Zona 1, Santiago Sacatepéquez, Guatemala.
Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Reprod Health. 2017 Nov 13;14(1):148. doi: 10.1186/s12978-017-0410-6.
Disrespectful and abusive maternity care is a common and pervasive problem that disproportionately impacts marginalized women. By making mothers less likely to agree to facility-based delivery, it contributes to the unacceptably high rates of maternal mortality in low- and middle-income countries. Few programmatic approaches have been proposed to address disrespectful and abusive maternity care.
Care navigation was pioneered by the field of oncology to improve health outcomes of vulnerable populations and promote patient autonomy by providing linkages across a fragmented care continuum. Here we describe the novel application of the care navigation model to emergency obstetric referrals to hospitals for complicated home births in rural Guatemala. Care navigators offer women accompaniment and labor support intended to improve the care experience-for both patients and providers-and to decrease opposition to hospital-level obstetric care. Specific roles include deflecting mistreatment from hospital staff, improving provider communication through language and cultural interpretation, advocating for patients' right to informed consent, and protecting patients' dignity during the birthing process. Care navigators are specifically chosen and trained to gain the trust and respect of patients, traditional midwives, and biomedical providers. We describe an ongoing obstetric care navigator pilot program employing rapid-cycle quality improvement methods to quickly identify implementation successes and failures. This approach empowers frontline health workers to problem solve in real time and ensures the program is highly adaptable to local needs.
Care navigation is a promising strategy to overcome the "humanistic barrier" to hospital delivery by mitigating disrespectful and abusive care. It offers a demand-side approach to undignified obstetric care that empowers the communities most impacted by the problem to lead the response. Results from an ongoing pilot program of obstetric care navigation will provide valuable feedback from patients on the impact of this approach and implementation lessons to facilitate replication in other settings.
不尊重和虐待产妇护理是一个普遍存在的问题，它不成比例地影响到边缘化的妇女。通过使母亲不太可能同意在医疗机构分娩，它导致了中低收入国家不可接受的高孕产妇死亡率。很少有方案性的方法被提出来解决不尊重和虐待产妇护理的问题。
护理导航是由肿瘤学领域首创的，旨在通过在碎片化的护理连续体中提供联系，改善弱势群体的健康结果，并促进患者自主权。在这里，我们描述了护理导航模型在危重新生儿转诊到医院接受复杂家庭分娩的新应用，在危重新生儿转诊到医院接受复杂家庭分娩的新应用。护理导航员为妇女提供陪伴和分娩支持，旨在改善护理体验——为患者和提供者——并减少对医院级产科护理的反对。具体角色包括从医院工作人员那里转移虐待行为，通过语言和文化翻译改善提供者的沟通，倡导患者知情同意的权利，并在分娩过程中保护患者的尊严。护理导航员是经过专门挑选和培训的，以获得患者、传统助产士和生物医学提供者的信任和尊重。我们描述了一个正在进行的产科护理导航员试点计划，该计划采用快速循环质量改进方法，迅速确定实施的成功和失败。这种方法赋予了一线卫生工作者实时解决问题的能力，并确保该计划高度适应当地的需求。
护理导航是克服医院分娩“人文障碍”的一种很有前途的策略，通过减轻不尊重和虐待护理来实现。它提供了一种对不体面产科护理的需求方方法，使受该问题影响最大的社区能够领导应对措施。正在进行的产科护理导航试点计划的结果将从患者那里获得关于这种方法的影响的宝贵反馈意见，并为在其他环境中复制提供实施经验教训。
