Truong Samantha, Montaño Mariana, Sullivan Margaret M, Macias Valeria, Flores Hugo, Mata Hellen, Molina Rose L
Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA.
Compañeros En Salud (Partners In Health-Mexico), Calle Primera Poniente Sur #25, Ángel Albino Corzo, Chiapas, Mexico, 30370.
Midwifery. 2023 Jan;116:103507. doi: 10.1016/j.midw.2022.103507. Epub 2022 Oct 13.
To assess trends in childbirth at a hospital-birth center among women living in Compañeros En Salud (CES)-affiliated communities in Chiapas, Mexico and explore barriers to childbirth care. Our hypothesis was that despite interventions to support and incentivize childbirth at the hospital-birth center, the proportion of births at the hospital-birth center among women from Compañeros En Salud-affiliated communities has not significantly changed after two years. We suspected that this may be due to structural factors impacting access to care and/or perceptions of care impacting desire to deliver at the birth center.
This explanatory mixed-methods study included a retrospective Compañeros En Salud maternal health census review followed by quantitative surveys and semi-structured qualitative interviews.
Participants were women living in municipalities in the mountainous Sierra Madre region of Chiapas, Mexico who received prenatal care in one of 10 community clinics served by Compañeros En Salud. Participants were recruited if they gave birth anywhere other than the primary-level rural hospital and adjacent birth center supported by Compañeros En Salud, either at home or at other facilities.
We compared rates of birth at the hospital-birth center, other health facilities, and at home from 2017-2018. We conducted surveys and interviews with women who gave birth between January 2017-July 2018 at home or at facilities other than the hospital-birth center to understand perceptions of care and decision-making surrounding childbirth location.
We found no significant difference in rates of overall number of women birthing at the hospital-birth center from Compañeros En Salud-affiliated communities between 2017 and 2018 (p=0.36). Analysis of 158 surveys revealed distance (30.4%), time (27.8%), and costs (25.9%) as reasons for not birthing at the hospital-birth center. From 27 interviews, negative perceptions and experiences of the hospital included low-quality and disrespectful care, low threshold for medical interventions, and harm and suffering. Partners or family members influenced most decisions about childbirth location.
Interventions to minimize logistical barriers may not be sufficient to overcome distance and perceptions of low-quality, disrespectful care.
Better understanding of complex decision-making around childbirth will guide Compañeros En Salud in developing interventions to further meet the needs and preferences of birthing women in rural Chiapas.
评估墨西哥恰帕斯州与健康伙伴组织（CES）相关社区的妇女在医院分娩中心的分娩趋势，并探讨分娩护理的障碍。我们的假设是，尽管采取了干预措施来支持和激励在医院分娩中心分娩，但两年后，来自与健康伙伴组织相关社区的妇女在医院分娩中心的分娩比例并未显著变化。我们怀疑这可能是由于影响获得护理的结构因素和/或影响在分娩中心分娩意愿的护理观念所致。
这项解释性混合方法研究包括对健康伙伴组织孕产妇健康普查进行回顾性分析，随后进行定量调查和半结构化定性访谈。
参与者是居住在墨西哥恰帕斯州马德雷山脉地区各市的妇女，她们在由健康伙伴组织服务的10家社区诊所之一接受了产前护理。如果她们在由健康伙伴组织支持的基层农村医院和相邻分娩中心以外的任何地方分娩，无论是在家中还是在其他机构，均被纳入研究。
我们比较了2017 - 2018年在医院分娩中心、其他医疗机构和家中的分娩率。我们对2017年1月至2018年7月在家中或在医院分娩中心以外的机构分娩的妇女进行了调查和访谈，以了解她们对护理的看法以及围绕分娩地点的决策情况。
我们发现，2017年至2018年期间，来自与健康伙伴组织相关社区的妇女在医院分娩中心的总分娩率没有显著差异（p = 0.36）。对158份调查问卷的分析显示，距离（30.4%）、时间（27.8%）和费用（25.9%）是不在医院分娩中心分娩的原因。从27次访谈中得知，对医院的负面看法和经历包括护理质量低、不尊重患者、医疗干预门槛低以及伤害和痛苦。伴侣或家庭成员对大多数分娩地点的决策有影响。
尽量减少后勤障碍的干预措施可能不足以克服距离以及对低质量、不尊重护理的看法。
更好地理解围绕分娩的复杂决策将指导健康伙伴组织制定干预措施，以进一步满足恰帕斯州农村地区分娩妇女的需求和偏好。
