Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Curamericas/Guatemala, Calhuitz, San Sebastián Coatán, Huehuetenango, Guatemala.
Int J Equity Health. 2023 Feb 28;21(Suppl 2):204. doi: 10.1186/s12939-022-01758-6.
In Guatemala, Indigenous women have a maternal mortality ratio over twice that of non-Indigenous women. Long-standing marginalization of Indigenous groups and three decades of civil war have resulted in persistent linguistic, economic, cultural, and physical barriers to maternity care. Curamericas/Guatemala facilitated the development of three community-built, -owned, and -operated birthing centers, Casas Maternas Rurales (referred to here as Community Birthing Centers), where auxiliary nurses provided physically accessible and culturally acceptable clinical care. The objective of this paper is to assess the management of complications and the decision-making pathways of Birthing Center staff for complication management and referral. This is the sixth paper in the series of 10 articles. Birthing centers are part of the Expanded Census-based, Impact-oriented Approach, referred to as CBIO+.
We undertook an explanatory, mixed-methods study on the handling of pregnancy complications at the Birthing Centers, including a chart review of pregnancy complications encountered among 1,378 women coming to a Birthing Center between 2009 and 2016 and inductively coded interviews with Birthing Center staff.
During the study period, 1378 women presented to a Birthing Center for delivery-related care. Of the 211 peripartum complications encountered, 42.2% were successfully resolved at a Birthing Center and 57.8% were referred to higher-level care. Only one maternal death occurred, yielding a maternal mortality ratio of 72.6 maternal deaths per 100,000 live births. The qualitative study found that staff attribute their successful management of complications to frequent, high-quality trainings, task-shifting, a network of consultative support, and a collaborative atmosphere.
The Birthing Centers were able to resolve almost one-half of the peripartum complications and to promptly refer almost all of the others to a higher level of care, resulting in a maternal mortality ratio less than half that for all Indigenous Guatemalan women. This is the first study we are aware of that analyzes the management of obstetrical complications in such a setting. Barriers to providing high-quality maternity care, including obtaining care for complications, need to be addressed to ensure that all pregnant women in such settings have access to a level of care that is their fundamental human right.
在危地马拉，土著妇女的孕产妇死亡率是其他非土著妇女的两倍以上。土著群体长期受到边缘化，以及 30 年内战的影响，导致产妇保健服务在语言、经济、文化和实际方面存在持续障碍。危地马拉库拉梅拉斯组织促成了三个由社区建造、拥有和运营的生育中心的发展，即农村母婴之家（以下简称社区生育中心），辅助护士在那里提供可及和可接受的临床护理。本文的目的是评估生育中心工作人员在处理并发症和决策方面的管理，以处理并发症和转诊问题。这是该系列 10 篇文章中的第 6 篇。生育中心是扩展人口普查为基础、影响为导向的方法（简称 CBIO+）的一部分。
我们对生育中心处理妊娠并发症的情况进行了一项解释性、混合方法研究，包括对 2009 年至 2016 年间在生育中心分娩的 1378 名妇女的妊娠并发症进行图表审查，并对生育中心工作人员进行了归纳编码访谈。
在研究期间，1378 名妇女因分娩相关护理来到生育中心。在遇到的 211 例围产期并发症中，42.2%在生育中心得到成功解决，57.8%被转介到更高一级的护理。仅发生了一例产妇死亡，导致孕产妇死亡率为每 10 万例活产 72.6 例。定性研究发现，工作人员将其成功处理并发症归因于频繁、高质量的培训、任务转移、咨询支持网络以及协作氛围。
生育中心能够解决近一半的围产期并发症，并及时将几乎所有其他并发症转介到更高一级的护理，使孕产妇死亡率降至所有危地马拉土著妇女的一半以下。这是我们所知的第一个分析这种情况下产科并发症管理的研究。需要解决提供高质量产妇保健服务的障碍，包括获得并发症护理，以确保所有此类环境中的孕妇都能获得其基本人权的护理水平。
