Evaluation: Three models of skilled attendants at childbirth in Mexico

Background. Currently, physicians in Mexico attend 81.5% of all deliveries and most births occur in hospital. Despite this, over the past decade the reduction in the maternal rate has reached a plateau of approximately 80/100,000. Mexico is now evaluating MCH policies regarding inclusion of non-physician skilled attendants in maternity care and at birth as a strategy to improve obstetric care in public-sector hospitals. Purpose & Methods. The purpose of this presentation is to report on the strengths and weaknesses of obstetric care provided by three models for skilled attendance at birth: professional midwives (PPT*), obstetric nurses (EO*) and general physicians (MG*). The prospective cohort evaluation was conducted using quantitative and qualitative methods. Between August, 2006 and June, 2007 observers are attending births and collecting quality of care and outcome data in five hospitals across Mexico. We focus on evidence-based care practices and quality of care measures, based on criteria within the WHO/FIGO/ICM statement “Making Pregnancy Safer.” A preliminary analysis of 487 births observed between August and October was conducted in November, 2006. We will present the final quantitative results of the study at APHA. There were significant differences found between sites and between provider groups. In the final analysis, linear and logistic regression will be used to control for the influence of site on outcomes by type of provider. Results. Overall, PPT, MG, and EOs follow evidence-based care guidelines, (e.g., high rates vitamin K administration and antibiotic eye prophylaxis) with some important exceptions. We found that episiotomy and “limpieza uterina” are performed significantly less often by PPTs. Active management of 3rd stage and use of magnesium sulfate for treatment of pre-eclampsia are underutilized by all 3 provider types. There was no significant difference in either complications of delivery (pre-eclampsia, hemorrhage, or infection) or obstetric outcomes (apgars, birth weights, neonatal resuscitation) among the groups. Conclusion. Our preliminary findings indicate that non-physician skilled attendants represent an important, underutilized, and safe strategy for providing basic obstetric care. The results are important for setting MCH and workforce utilization policies in Mexico. * Abbreviation for Spanish terms