Midwifery Curriculum for Auxiliary Maternity Nurses: A Case Study in the Dominican Republic

Abstract

Although most deliveries in the Dominican Republic occur within hospitals, maternal mortality in that nation remains high. In nonteaching hospitals, almost all of the vaginal births are attended by maternity auxiliary nurses. This article reports on a series of educational conferences for maternity auxiliary nurses in 1 hospital that were developed in response to the maternal mortality rate there. These conferences, taught by a team of midwives from the continental United States and Puerto Rico, used a midwifery curriculum with a participatory action methodology. The educational initiative has developed into a nongovernmental organization named Proyecto ADAMES to build capacity among auxiliary nurses. A qualitative evaluation of the effectiveness of Proyecto ADAMES in improving the knowledge, skills, and attitudes of the auxiliary nurses revealed positive behavioral changes despite weak documentation of their newly acquired knowledge and skills. Findings suggest that midwifery education for auxiliary maternity nurses in the Dominican Republic may contribute to maternal mortality reduction.

Decision Making by Auxiliary Nurses to Assess Postpartum Bleeding in a Dominican Republic Maternity Ward

“…The auxiliaries did not follow a routine, nurse‐driven, postpartum assessment that emphasized teaching and self‐monitoring. This study’s findings confirmed the research team’s preliminary observations (Foster et al, 2005).…”

A community-based participatory research approach to explore community perceptions of the quality of maternal–newborn health services in the Dominican Republic

“…This study was one of the outcomes of a continuing international partnership between US midwives (one trained in medical anthropology) and Dominican nurses that was initiated in 2003. Earlier activities of the partnership have been reported elsewhere (Foster, 2009; Foster & Heath, 2007; Foster et al, 2006; Foster et al, 2005). Following an increase in maternal mortality cases within a six month period, the Dominican nurses identified delays in accessing care for complications as a factor contributing to maternal deaths.…”

Cultural Humility and the Importance of Long-Term Relationships in International Partnerships

“…These steps also include knowledge development, such as calculation of gestational age and clinical history taking. Also attitude changes, such as more satisfaction with their jobs and feeling closer to the women under their care, are part of the documented changes as a result of the partnership (Foster, Regueira, Burgos, & Sanchez, 2005).…”

“…The proactive stance of the nurses to address the problem of maternal mortality helped to shape a highly participatory program. The successes, documented in initial outcomes in knowledge, attitudes, and skills among the all nurses (auxiliary and licensed), have been the building blocks for specific improvements in the quality of care (Foster et al, 2005). When the project began in 2003, there were 32 nurses assigned to the maternity ward, which includes a triage ward as well as labor, delivery, and postpartum, and most were auxiliary nurses.…”