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)

Abstract

Background In Guatemala, Indigenous women have a maternal mortality ratio over twice that of non-Indigenous women. Long-standing marginalization of Indigenous groups and three decades of civil war have resulted in persistent linguistic, economic, cultural, and physical barriers to maternity care. Curamericas/Guatemala facilitated the development of three community-built, -owned, and -operated birthing centers, Casas Maternas Rurales (referred to here as Community Birthing Centers), where auxiliary nurses provided physically accessible and culturally acceptable clinical care. The objective of this paper is to assess the management of complications and the decision-making pathways of Birthing Center staff for complication management and referral. This is the sixth paper in the series of 10 articles. Birthing centers are part of the Expanded Census-based, Impact-oriented Approach, referred to as CBIO+. Methods We undertook an explanatory, mixed-methods study on the handling of pregnancy complications at the Birthing Centers, including a chart review of pregnancy complications encountered among 1,378 women coming to a Birthing Center between 2009 and 2016 and inductively coded interviews with Birthing Center staff. Results During the study period, 1378 women presented to a Birthing Center for delivery-related care. Of the 211 peripartum complications encountered, 42.2% were successfully resolved at a Birthing Center and 57.8% were referred to higher-level care. Only one maternal death occurred, yielding a maternal mortality ratio of 72.6 maternal deaths per 100,000 live births. The qualitative study found that staff attribute their successful management of complications to frequent, high-quality trainings, task-shifting, a network of consultative support, and a collaborative atmosphere. Conclusion The Birthing Centers were able to resolve almost one-half of the peripartum complications and to promptly refer almost all of the others to a higher level of care, resulting in a maternal mortality ratio less than half that for all Indigenous Guatemalan women. This is the first study we are aware of that analyzes the management of obstetrical complications in such a setting. Barriers to providing high-quality maternity care, including obtaining care for complications, need to be addressed to ensure that all pregnant women in such settings have access to a level of care that is their fundamental human right.

Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 1. Introduction and project description

“…The other papers in this supplement describe the implementation research methods [38] as well as the effects of the Project on population coverage of key maternal and child health interventions [39], nutrition [40], mortality [41], quality of maternity care at Community Birthing Centers [42], and women's empowerment [36] and well-being [43,44]. The final two papers in the supplement concern assessments of staff and key stakeholders about the CBIO+ Approach [45] and a summary of the findings along with a discussion of the broader implications of this work [46].…”

Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 8. Impact on women’s empowerment

“…The men's FGDs also all agreed that Curamericas/Guatemala had facilitated a change in empowerment of women through the following: the Community Birthing Centers (called Casas Maternas Rurales and referred to locally as Casas and described further in Papers 1 and 6 [31,46]), the education and health services provided to the women, the bringing of women together and the encouragement of them to speak and participate, and the general community development fostered by the Project.…”

“…Table 1 provides a brief description of the CBIO+ Approach. In addition to Papers 1, 2, 7 and the current paper, there are six additional papers in this series [43][44][45][46][47][48].…”

Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 7. The empowering effect of Care Groups

“…This article is part of a series of 10 articles that summarize the findings of an evaluation of the Project [4][5][6][7][8][9][10][11][12]. In this article we describe changes in aspects of women's empowerment, including perceived respect/social status, self-efficacy, decision-making autonomy, and formation of social capital, as reported by participants in the Care Group activities of the Project.…”