An Adapted Safe Childbirth Checklist for Mexico

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Overview

Ensuring quality obstetric care and continuity and consistency of practice.

Involved development of an application that guides obstetric nurses through essential evidence-based childbirth practices and respectful birthing practices. Application returns indicators for real-time monitoring and continuous quality improvement.

Context

In Mexico, 94% of births occurred in a facility in 2012, while only 60% of births occurred in a facility in Chiapas, one of the poorest states in Mexico. This disparity in facility-based births has been attributed to poor access to health care services among marginalized, poor women and to traditional preferences and norms around home births in some indigenous communities.

Maternal centers have been opened in Chiapas as a safe place for low-risk deliveries that might be more appealing to rural, indigenous women than a traditional hospital. However, many have been fraught with low volume due to transportation and childcare barriers, perceived poor quality of care, and preference for home births.

Challenge

A maternal center (“casa materna”) exists adjacent to the district hospital in Revolución, Chiapas. The catchment area of this maternal center includes approximately 65,000 people from 5 CES-affiliated communities (population ~ 6600) and many other affiliated communities. In collaboration with the MacArthur Foundation and the Ministry of Health, CES will provide training for government-appointed obstetric nurses who will staff the maternal center.

Solution

Implementation of a training program at the Maternal Center in Revolución, Chiapas that promotes respectful maternity care  and provides coaching around evidence-based practices using the World Health Organization’s Safe Childbirth Checklist (SCC) adapted to the local standard of care in Mexico.

Results

Development and implementation of a mobile platform for the WHO Safe Childbirth Checklist with integrated indicators and checkpoints for ensuring respectful maternity care. Midwives and obstetric nurses who work in the rural maternity center are using the mobile platform for clinical guidance and decision support, standardization of care, and for collecting indicators for ongoing program evaluation and quality improvement. Supervisors may occasionally use this platform during observation of the midwives and obstetric nurses to obtain a periodic independent assessment of their adherence with the integrated checklist.

Project Timeline

This project took six months to complete from kick-off meeting to presentation of final deliverables. Click the button below for a detailed timeline.

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