198213 Trained birth attendants In Mexico: How do general physicians, obstetric nurses and professional midwives rank compared to WHO evidence based practice guidelines?

Wednesday, November 11, 2009: 8:30 AM

Dilys Walker, MD , Reproductive Health, Mexican National Institute of Public Health, Cuernavaca, Mexico
Leslie Cragin, CNM, PhD , Department of Ob/Gyn and Reproductive Sciences, UCSF, Menlo Park, CA
Lisa De Maria, MS , Health Systems Research, Mexican National Institue of Public Health, Cuernavaca, Mexico
Leticia Suarez, MS , Reproductive Health, Mexican National Institue of Public Health, Cuernavaca, Mexico
Dolorez Gonzalez, MA , Reproductive Health, Mexican National Institute of Public Health, Cuernavaca, Mexico
Minerva Romero, MD , Reproductive Health, Mexican National Institute of Public Health, Cuernavaca, Mexico
Marcela Smid, MA, MS , School of Medicine, University of California - San Franciso, San Francisco, CA
  
Introduction

Evidence based practice guidelines are useful to evaluate both beneficial and harmful practices. We aimed to assess and compare the quality of basic obstetric care provided by general physicians (GP), obstetric nurses (ON) and professional midwives (PM) in Mexico.

Methods

We assessed admission, labor and delivery care offered by these three provider types using the WHO guidelines for evidence based practices in normal birth plus additional variables for obstetric outcomes and neonatal care. Vaginal births were observed in 5 hospitals in 5 states from June 2006 until July 2007. Data was entered directly into a laptop ACCESS program and then transferred to STATA for analysis. We created 5 indices: positive practices at admission (4 items), positive practices during labor and delivery (9 items), practices to eliminate or decrease (11 items), obstetric outcomes (4 items), and neonatal care (3 items). We assessed each provider type's performance using Spearman's correlation to a high or low score on the index

Results

We observed 876 independently managed normal vaginal deliveries (GP 537, ON 194, PM 145,) attended by 109 providers (53 GP, 9 PM, 19 ON). Significant differences were found for the three provider types compared to the index. For positive practices during labor and delivery (48%PM, 27%ON, 3%GP scoring in the high range), Spearman's Rho was (P<.05) 0.38 PM, 0.34ON, - 0.58GP; for practices to be decreased/eliminated (87%PM, 10%PM, 13%GP score in the low range) with a Spearman's Rho (<.05) of -0.64PM, 0.16ON, 0.34GP; for neonatal practices (26%PM, 98%ON, 92%PM scored in the high range), with a Spearman's Rho (P<.05) of -0.66PM, 0.22ON, 0.31GP

Conclusion

Non physician providers, particularly PM, act in accordance with WHO guidelines for labor and delivery practices and for avoiding practices that should be decreased or eliminated. Further work is needed to train PM in neonatal care guidelines. If the capacity to train PM and ON is expanded, they will be able to assist in improving the quality of obstetric care in Mexico, where in general, only physicians are considered qualified to independently attend births.

Learning Objectives:
1. Compare evidence based obstetric practices performed by general physicians, obstetric nurses and professional midwives in Mexico. 2. Discuss the potential for non-physician providers to provide basic obstetric care in Mexico.

Keywords: Maternal Care, Midwifery

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I lived and worked in Mexico for one year to participate in this study and was in volved in supervision and data collection.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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