Abstract
Problem
In Mexico, women are often disrespected and abused during birth, evidence-based practices
are seldom used, while outdated and dangerous procedures linger.
Background
Disrespectful and abusive practices in Mexico have been reported but are not necessarily
well-documented; none of the reports so far have relied on direct observation of births.
Aim
To describe birth practices and factors associated with respectful and evidence-based
care at 15 referral hospitals in Mexico.
Methods
We observed 401 births from 2010–2016. We analysed woman, provider, and hospital characteristics
and their association with the performance of 14 evidence-based and 15 respectful
birth practices via descriptive statistics and multiple logistic regression models.
Findings
Only in four births were all the analysed evidence-based and respectful-birth practices
performed. Essential interventions like uterine massage was only given to 46.1% of
women and the administration of a uterotonic soon after birth only occurred in 58.3%
of births. Professionals who were trained in respectful birth care were more likely
to address women by their name (Odds Ratio = 3.34, p < 0.05), allow consumption of liquids during labour (Odds Ratio = 31.6, p < 0.05), encourage skin-to-skin contact (Odds Ratio = 31.82, p < 0.05), and examine the placenta after birth (Odds Ratio = 16.55, p < 0.01); they were less likely to perform episiotomies (Odds Ratio = 0.27, p < 0.05).
Discussion
This study reveals low rates of evidence-based practices and respectful maternity
care but shows training in the topic can have a considerable positive impact. Our
results call for further efforts to improve the quality of maternal healthcare, a
universal right.
Abbreviations:
WHO (World Health Organisation), AMTSL (active management of the third step of labour), ANOVA (analysis of variance), OR (odds ratio)Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Women and BirthAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Health-Related Sustainable Development Goals (SDG) Global Burden of Disease (GBD).University of Washington, Seattle, EUA2019 (. (Accessed 14 December 2019))
- Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care.Lancet. 2014; 384: 1129-1145
- Use of active management of the third stage of labour in seven developing countries.Bull. World Health Organ. 2009; 87: 207-215
- “Good obstetrics” revisited: too many evidence-based practices and devices are not used.Int. J. Gynecol. Obstet. 2006; 94: 179-184
- Standards for Maternal and Neonatal Care.WHO, 2019 (. (Accessed 15 January 2020))
- Guía de Práctica Clínica: Vigilancia y manejo del trabajo de parto en embarazo de bajo riesgo.Secretaría de Salud, México2014 (. (Accessed 14 December 2019))
- Advantage of delayed umbilical cord clamping in newborninfant.Arch Pediatr. 2013; 20: 1022-1027
- Effect of early skin-to-skin contact on breast-feeding.J. Obstet. Gynaecol. 2013; 33: 695-696
- Calidad de la atención durante el parto normal en establecimientos públicos de salud en el estado de Oaxaca.Revista de Investigación médica de Oaxaca. 2013; 1: 17-36
- Monitoreo sobre el tiempo de pinzado y corte de cordón umbilical: Vigilancia de nuevas estrategias para la atención del parto.Perinatol. Reprod. Hum. 2014; 28: 134-138
- Skilled birth attendants in Mexico: how does care during normal birth by general physicians, obstetric nurses, and professional midwives compare with World Health Organization evidence-based practice guidelines?.J. Midwifery Womens Health. 2012; 57: 18-27
- Episiotomy for vaginal birth.Cochrane Database Syst. Rev. 2009; (CD000081)https://doi.org/10.1002/14651858.CD000081.pub2
- Managing complications in pregnancy and childbirth: a guide for midwives and doctors.Department of Reproductive Health and Research, WHO, 2003
- The effects of uterine fundal pressure (Kristeller maneuver) on pelvic floor function after vaginal delivery.Arch. Gynecol. Obstet. 2012; 286: 1135-1139
- Maternal rib fracture after manual uterine fundal pressure.Rural Remote Health. 2012; 12: 2062
- Fundal pressure in second stage of labor (Kristeller maneuver) is associated with increased risk of levator ani muscle avulsion.Ultrasound Obstet. Gynecol. 2019; 53: 95-100
- Can a simulation-based training program impact the use of evidence based routine practices at birth? Results of a hospital-based cluster randomized trial in Mexico.PLoS One. 2017; 12e0172623https://doi.org/10.1371/journal.pone.0172623
- Efficacy of routine postpartum uterine exploration and manual sponge curettage.J. Fam. Pract. 1989; 28: 172-176
- Violence against women in Mexico: a study of abuse before and during pregnancy.Am. J. Public Health. 2003; 93: 1110-1116
- El maltrato en las salas de parto: reflexiones de un gineco-obstetra.Rev. CONAMED. 2010; 15: 147-151
- Nueva evidencia a un viejo problema: El abuso de las mujeres en las salas de parto.Rev. CONAMED. 2013; 18: 14-20
- “If we’re here, it’s only because we have no money…” discrimination and violence in Mexican maternity wards.BMC Pregnancy Childbirth. 2018; 18: 244
- WHO Recommendation on Respectful Maternity Care During Labour and Childbirth.WHO, 2018 (. (Accessed 1 June 2019))
- Exploring evidence for disrespect and abuse in facility-based childbirth.Report of a Landscape Analysis. Harvard School of Public Health, 2010 (USAID-TRAction Project)
- Disrespect and abuse of women in childbirth: challenging the global quality and accountability agendas.Lancet. 2014; 384: e42-4
- The Prevention and Elimination of Disrespect and Abuse During Facility-based Childbirth.WHO, 2014 (. (Accessed 10 July 2019))
- Respectful Maternity Care: The Universal Rights of Childbearing Women.White Ribbon Alliance, 2011 (. (Accessed 23 January 2020))
- Obstetrics in a time of violence: mexican midwives critique routine hospital practices.Med. Anthropol. Q. 2015; 29: 437-454
- Mexico’s midwives enter the mainstream.Bull. World Health Organ. 2008; 86: 244-245
- Violencia obstétrica. Un enfoque de derechos humanos.GIRE, 2015 (. (Accessed 14 December 2019))
- Senado aprueba sancionar violencia obstétrica.Senado de la Republica, México2014 (. (Accessed 1 November 2019))
- Care in normal birth: a practical guide. Technical Working Group, World Health Organisation.Birth. 1997; 24: 121-123
- Health Care Utilisation: Surgical Procedures.OECD, 2019 (. (Accessed 1 November 2019))
- Una epidemia de cesáreas innecesarias en México.2017 (México. https://www.nytimes.com/es/2017/08/28/una-epidemia-de-cesareas-innecesarias-en-mexico/?smid=wa-share-es. (Accessed 20 August 2019))
- Omisión e Indiferencia: Derechos Reproductivos en México-Violencia Obstétrica.GIRE, México2018 (. (Accessed 1 November 2019))
- Subsistema de Información sobre Nacimientos (SINAC).2016 (México. http://www.dgis.salud.gob.mx/contenidos/sinais/s_sinac.html. (Accessed 18 September 2019))
- Ethical challenges in medical community internships: perspectives from medical interns in the Philippines.Health Hum. Rights. 2019; 21: 141-147
- Unpacking the null: a post-hoc analysis of a cluster-randomised controlled trial of the WHO Safe Childbirth Checklist in Uttar Pradesh, India (BetterBirth).Lancet Glob. Health. 2019; 7: e1088-e1096
- Physician age and outcomes in elderly patients in hospital in the US: observational study.BMJ. 2017; 357: j1797
- Like night and day—shedding light on off-hours care.N. Engl. J. Med. 2008; 358: 2091-2093
- Hospitals by day, dispensaries by night: hourly fluctuations of maternal mortality within Mexican health institutions, 2010–2014.PLoS One. 2018; 13e0198275
- ‘When helpers hurt’: women’s and midwives’ stories of obstetric violence in state health institutions, Colombo district, Sri Lanka.BMC Pregnancy Childbirth. 2018; 18: 211
- Health providers pass knowledge and abilities acquired by training in obstetric emergencies to their peers: the average treatment on the treated effect of PRONTO on delivery attendance in Mexico.BMC Pregnancy Childbirth. 2018; 18: 232
- Integrating human rights into medical education.Virtual Mentor. 2004; 6: 398-400
- Human rights education in woman care.Public Health Rev. 2017; 38: 14
- The state of the world’s midwifery 2014: a universal pathway.A Woman’s Right to Health. 2014 (. (Accessed 14 December 2019))
- El estado de las parteras en el mundo 2014: oportunidades y retos para México.2014 (. (Accesed 1 November 2019))
- Strengthening Midwifery in Mexico.2019 (https://www.macfound.org/press/perspectives/strengthening-midwifery-mexico/. (Accesed 1 November 2019))
- Fortalecer la partería: Una deuda pendiente con las mujeres de México [Strengthening Midwifery: An Outstanding Debt to the Women of Mexico].John D. and Catherine T MacArthur Foundation, 2016 (. (Accesed 27 January 2020))
- Is it possible to incorporate evidence-based professional midwifery practices into public health services in Mexico?.Women Birth. 2019; (30188–4. S1871-192)https://doi.org/10.1016/j.wombi.2019.05.008
- The mistreatment of women during childbirth in health facilities globally: a mixed methods systematic review.PLos Med. 2015; 12e100184
Article info
Publication history
Published online: February 25, 2020
Accepted:
February 12,
2020
Received in revised form:
February 6,
2020
Received:
June 13,
2019
Identification
Copyright
© 2020 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
