Improving the experience of facility-based delivery for vulnerable women through obstetric care navigation: a qualitative evaluation

Abstract

Background Global disparities in maternal mortality could be reduced by universal facility delivery. Yet, deficiencies in the quality of care prevent some mothers from seeking facility-based obstetric care. Obstetric care navigators (OCNs) are a new form of lay health workers that combine elements of continuous labor support and care navigation to promote obstetric referrals. Here we report qualitative results from the pilot OCN project implemented in Indigenous villages in the Guatemalan central highlands. Methods We conducted semi-structured interviews with 17 mothers who received OCN accompaniment and 13 staff—namely physicians, nurses, and social workers—of the main public hospital in the pilot’s catchment area (Chimaltenango). Interviews queried OCN’s impact on patient and hospital staff experience and understanding of intended OCN roles. Audiorecorded interviews were transcribed, coded, and underwent content analysis. Results Maternal fear of surgical intervention, disrespectful and abusive treatment, and linguistic barriers were principal deterrents of care seeking. Physicians and nurses reported cultural barriers, opposition from family, and inadequate hospital resources as challenges to providing care to Indigenous mothers. Patient and hospital staff identified four valuable services offered by OCNs: emotional support, patient advocacy, facilitation of patient-provider communication, and care coordination. While patients and most physicians felt that OCNs had an overwhelmingly positive impact, nurses felt their effort would be better directed toward traditional nursing tasks. Conclusions Many barriers to maternity care exist for Indigenous mothers in Guatemala. OCNs can improve mothers’ experiences in public hospitals and reduce limitations faced by providers. However, broader buy-in from hospital staff—especially nurses—appears critical to program success. Future research should focus on measuring the impact of obstetric care navigation on key clinical outcomes (cesarean delivery) and mothers’ future care seeking behavior.

Patient navigation in women’s health care for maternal health and noncancerous gynecologic conditions: a scoping review

“…Three studies assessed the effects of a patient navigation program within a single cohort [ 28 , 31 , 34 ]. The remaining studies varied in design, including randomized controlled trials (n=2) [ 27 , 29 ], pre- and post-studies (n=2) [ 25 , 35 ], a case-control study (n=1) [ 26 ], and a qualitative study (n=1) [ 23 ]. Only six were primary interventional studies [ 22 , 24 , 28 - 30 , 35 ].…”

“…Each study included in this review specifically focused on women or families with unique socioeconomic and obstetric statuses. The majority of these studies involved participants with low incomes (n=8) [ 24 - 26 , 30 - 34 ], followed by those from ethnic minority groups (n=4) [ 22 , 23 , 29 , 35 ]. One of the remaining studies focused on women living on islands far removed from well-equipped mainland medical centers [ 28 ], while another study included women who had an unplanned cesarean section during delivery [ 27 ] ( Table 1 ).…”

“…Three studies, however, presented both quantitative and qualitative data [ 27 , 31 , 34 ]. Only one study [ 23 ] exclusively presented a qualitative analysis.…”

Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 6. Management of pregnancy complications at Community Birthing Centers (Casas Maternas Rurales)

“…Indigenous women throughout the world often seek culturally relevant, respectful readily accessible and affordable care. They generally consider care from the formal health system as being only for complications and emergencies [ 34 , 35 ]. Common causes elsewhere in Guatemala for not accepting recommendations for referral include (1) opposition from the husband or other family member and (2) difficulties (including costs) in arranging transport [ 36 ].…”

“…Common causes elsewhere in Guatemala for not accepting recommendations for referral include (1) opposition from the husband or other family member and (2) difficulties (including costs) in arranging transport [ 36 ]. Experiences have been reported from the central highlands of Guatemala with obstetric care navigators, who are community-based workers employed to accompany Indigenous mothers in need of referral to a hospital to provide support and to improve the patient experience with facility-level obstetric care [ 35 , 37 ]. Support Women at the Birthing Centers in our Project Area also have performed this role.…”