Associations with perineal trauma during childbirth at home and in health facilities in indigenous municipalities in southern Mexico: a cross-sectional cluster survey

Abstract

BackgroundEpisiotomy and perineal tears remain common in vaginal deliveries. This study estimated the frequency of and factors associated with perineal tears, episiotomies, and postnatal infections among women in two predominantly indigenous municipalities in southern Mexico, where traditional midwives play an important role in women’s health.MethodsA cross-sectional study contacted women who gave birth in the previous three years. An administered questionnaire asked about place of delivery, birthing position, birth attendant, episiotomy, perineal tears, and wound infection after delivery. Cluster adjusted bivariate and then multivariate analysis examined factors potentially associated with self-reported perineal trauma (episiotomy and/or perineal tear). Key informant interviews sought insights into some of the findings.ResultsAmong women with a vaginal delivery, 71% (876/1238) of indigenous women and 18% (36/197) of non-indigenous women delivered at home. Some 17% (247/1416) of women overall, and 33% (171/525) of those delivering in a health facility, reported an episiotomy during delivery. Among 171 women reporting an episiotomy in a health facility, 30% (52) also reported a perineal tear. Overall, 13% (190/1412) of women reported they had a perineal tear during delivery, 17% (86/515) of those delivering in a health facility and 12% (104/897) of those delivering at home. A quarter of the women had self-reported perineal trauma during their last delivery, 38% (196/511) of those delivering in a health facility and 18% (160/893) of those delivering at home. In bivariate analysis, indigenous ethnicity, home delivery, upright posture in labour, and delivery by a traditional midwife were associated with a lower risk of perineal trauma, while primiparas had a higher risk. In the final multivariate model, delivery by a traditional midwife was protective (ORa 0.41, 95%CIca 0.32–0.54) and primiparity was a risk factor (ORa 2.01, 95%CIca 1.5–2.68) for perineal trauma. Women suggested that fear of bad treatment and being cut made them unwilling to deliver in health facilities.ConclusionsThe rate of perineal trauma among women giving birth in indigenous communities could be reduced by efforts to decrease the use of episiotomies in health facilities, and by opening a dialogue with traditional midwives to increase their interaction with formal health services.

Bridging Western and Indigenous knowledge through intercultural dialogue: lessons from participatory research in Mexico

“…Services are underfunded and poorly staffed. 37 Traditional Indigenous midwives ( parteras tradicionales ) are the providers of choice for most Indigenous women, particularly in remote villages where they are the only skilled practitioners available for antenatal and delivery care. But traditional Indigenous midwifery has become attenuated and does not on its own guarantee healthy childbirth in all cases.…”

“…Indigenous women in Southern Guerrero prefer home deliveries and often shun Western obstetric care in fear of routine practices considered disrespectful in their culture. 37 In this context, maternal mortality is 10 times higher in Indigenous communities than it is in the rest of the state. 40…”

“…Birth complications such as self-reported perineal trauma were less frequent in traditional midwife-assisted births (24%, 120/656) than in births assisted by a doctor or nurse (39%, 210/543). 37 Women were more likely to attend for antenatal care in health units if a traditional midwife had told them to do so, and most women and their families accepted midwife advice to deliver in a Western healthcare unit.…”

Fuzzy cognitive mapping and soft models of indigenous knowledge on maternal health in Guerrero, Mexico

“…The perceived lack of respect for their traditional knowledge systems leads to an aversion to conventional health services among many indigenous people [11]. This hinders access to conventional medical facilities [12]. In the indigenous communities in the southern mountainous areas of Guerrero in Mexico, traditional midwives are either the only source of perinatal care or the one that women prefer [12,13].…”

“…This hinders access to conventional medical facilities [12]. In the indigenous communities in the southern mountainous areas of Guerrero in Mexico, traditional midwives are either the only source of perinatal care or the one that women prefer [12,13].…”