Educating Skilled Birth Attendants in Mexico: Do the Curricula Meet International Confederation of Midwives Standards?

Abstract

Although the majority of births in Mexico are attended by skilled birth attendants, maternal mortality remains moderately high, raising questions about the quality of training and delivery care. We conducted an exhaustive review of the curricula of three representative schools for the education and clinical preparation of three types of birth attendant -obstetric nurses, professional midwives and general physicians -National Autonomous University of Mexico (UNAM) School of Obstetric Nursing; CASA Professional Midwifery School; and UNAM School of Medicine, Iztacala Campus. All curricular materials were measured against the 214 indicators of knowledge and ability in the International Confederation of Midwives (ICM) skilled attendant training guidelines. The CASA curriculum covered 83% of the competencies, 93% of basic knowledge and 86% of basic abilities, compared with 54%, 59% and 64% for UNAM Obstetric Nursing School and 43%, 60% and 36% for UNAM School of Medicine, respectively. Neither the Obstetric Nursing School nor the School of Medicine documented the quantity or types of clinical experience required for graduation. General physicians attend the most births in Mexico, yet based on our analysis, professional midwives had the most complete education and training as measured against the ICM competencies. We recommend that professional midwives and obstetric nurses should be formally integrated into the public health system to attend deliveries. A2007 Reproductive Health Matters. All rights reserved.

Non-physician providers of obstetric care in Mexico: Perspectives of physicians, obstetric nurses and professional midwives

“…While a complete overview of the training curriculum for each provider and the differences between them can be found elsewhere [10], it is relevant to examine the comfort levels of providers, comprehensiveness of training and the limitations of practice in the various models of care. To frame this discussion, we selected three specific practices that illustrate their perspectives on autonomy, skills and practice norms: episiotomy, non-pharmacologic pain management and uterine wiping.…”

“…Recent quantitative evidence shows that Mexican-trained midwives and obstetric nurses perform at a similar level or even above that of general physicians in process indicators of obstetric care and their patients have similar neonatal and obstetric outcomes [10,11]. Yet, incorporating these non-physician providers presents challenges to the health system in terms of resistance by current health provider cadres and managers, frequently due to unfamiliarity with these other provider types, lack of clarity regarding optimizing human resources at the primary, secondary and tertiary levels, and differences in approaches to care.…”

“…In Mexico, there are two non-physician models that meet criteria for skilled attendants as defined by International Confederation of Midwives and adopted by the WHO [8,9]: professional midwives and obstetric nurses [10]. There are limited midwifery training programs and opportunities in Mexico, which vary in terms of requirements and structure.…”

“…A curriculum review [10] followed by a transversal observational study of professional midwives, obstetric nurses and general practice physicians demonstrated that professional midwives and obstetric nurses perform at the same or superior levels as their general physician counterparts in the provision of labor and delivery care [11]. However, it has been observed that these providers face structural and individual barriers to their greater integration into the Mexican health system.…”

Obstetric Care and Method of Delivery in Mexico: Results from the 2012 National Health and Nutrition Survey

“…Countries like the Netherlands and the United Kingdom, where care for a high percentage of child births is provided by midwives show a different reality in terms of the proportion of cesarean sections: 14.30% for the Netherlands, and 23.99% for the United Kingdom [48]. However, in order to achieve a significant presence of midwives in health institutions in Mexico, it is necessary to overcome certain previously documented challenges [49], [50], such as barriers on training and the development of these professionals and the factors that hinder their incorporation to the health system within a framework of reduced medicalization of delivery services. Reverting the growing trend of delivery by cesarean section across the country requires integrated strategies that include some of the following aspects, which were previously documented [51]:…”