AI Article Synopsis

  • In Guatemala, 70% of births happen outside health facilities, often supported by traditional birth attendants (TBAs), despite recommendations for skilled birth attendants (SBAs) due to better health outcomes.
  • A new accredited professional midwifery school is set to open in 2017, aiming to address these challenges in rural indigenous communities and improve the integration of professional midwifery into health systems.
  • Interviews with health professionals revealed a lack of understanding of professional midwifery initially, but once defined, many expressed a willingness to collaborate with midwives while also highlighting concerns about potential resistance and varying expectations on the roles and oversight of midwives in community births.

Article Abstract

Background: Despite recommendations that women give birth with a skilled birth attendant (SBA), 70% of births in Guatemala occur outside health facilities with informally trained traditional birth attendants (TBAs). To increase SBA in rural, indigenous communities, a professional midwifery school accredited by the government is scheduled to open in 2017. Drawing from Filby's model on barriers to the successful integration of professional midwifery into health systems, this paper aims to identify threats - and facilitators-toward professional midwifery's re-introduction in Guatemala.

Methods: To elucidate perceptions, attitudes and expectations towards professional midwifery, qualitative, in-depth interviews were conducted with 32 physicians, nurses, and TBAs in six health centers and with key decision makers and professional midwives (PMs) in Guatemala City. We conducted open and axial coding in Atlas.ti and performed normative comparisons of participants' attitudes, perceptions, and expectations with the National Vision for professional midwifery and relative comparisons within and across disciplinary subgroups.

Results: Unprompted, physicians, nurses and TBAs were unable to correctly define professional midwifery. Yet, when professional midwifery was defined for them, they expressed willingness to work with PMs, seeing them as a needed human resource, instrumental in providing intercultural care and strengthening facility relationships with TBAs. Some stakeholders anticipated resistance toward PMs due to provider turf issues. Notable differences in expectations among all groups included ideas for supervision of and by the PMs and the PM's role in monitoring women and conducting births in communities alongside TBAs.

Conclusions: Facilitators to professional midwifery's success include national political will, stakeholders' uniformity of vision, and the potential for improved intercultural care. Barriers are mostly professional in nature, including impediments to autonomous practice by PMs, hierarchical challenges, and turf issues. A specific road map addressing the identified barriers is needed for professional midwifery to succeed in reducing maternal health disparities in Guatemala.

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Source
http://dx.doi.org/10.1016/j.socscimed.2017.05.005DOI Listing

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