In Mexico, women are often disrespected and abused during birth, evidence-based practices are seldom used, while outdated and dangerous procedures linger.
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.
To describe birth practices and factors associated with respectful and evidence-based care at 15 referral hospitals in Mexico.
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.
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).
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)
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- 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))http://www.cenetec.salud.gob.mx/descargas/gpc/CatalogoMaestro/052_GPC_VigilanciaManejodelParto/IMSS_052_08_EyR.pdf
- 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))https://extranet.who.int/rhl/topics/preconception-pregnancy-childbirth-and-postpartum-care/care-during-childbirth/who-recommendation-respectful-maternity-care-during-labour-and-childbirth
- 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))http://comunicacion.senado.gob.mx/index.php/informacion/boletines/12513-senado-aprueba-sancionar-violencia-obstetrica.html
- 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))https://www.macfound.org/media/files/Strengthening_Midwifery_in_Mexico_Three-year_Progress_Report_revised_7_junio2019.pdf
- 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
Published online: February 25, 2020
Accepted: February 12, 2020
Received in revised form: February 6, 2020
Received: June 13, 2019
© 2020 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.