Paper
Friday, July 15, 2005
Profiling Midwifery Services in the Americas -- Models of Childbirth Care
Kari M. Stone, BSN, MPH, Detachment 2, 13th Air Force, United States Air Force, Hickam AFB, HI, USA, Karen Odberg Pettersson, RMN, MNSc, MPH, PhD, Department of Public Health Sciences/ Division of International Health (IHCAR), Karolinska Institutet, Stockholm, Sweden, and Sandra Land, RN, PhD, Unit of Health Services Organization, Pan American Health Organization, Washington, D.C, DC, USA.
| Learning Objective #1: Identify five models of childbirth care |
| Learning Objective #2: Describe the role midwifery has in decreasing maternal mortality in the Americas |
Background: The World Health Organization (WHO) has moved from the initial Safe Motherhood Initiative (SMI) towards the “Making Pregnancy Safer” project in a global effort to improve maternal and perinatal health. WHO is presently undertaking a worldwide mapping of maternity services in which mapping of midwifery services is included as a specific item. The Pan American Health Organization (PAHO) has decided to undertake similar efforts to delineate midwifery services and practices in the Americas and the Caribbean. The actual and potential contribution of midwifery services to making pregnancy safer for mothers and infants has not been systematically analyzed in the countries of the Region, a task that is regarded as crucial in order to provide recommendations and technical assistance to the countries.
Methods: A literature review was conducted in order to identify models of maternal health care services in the Americas. Models were designed of the different approaches to care during childbirth identified in the literature and then countries were categorized.
Results: The model presenting the lowest rates of maternal mortality is Model III, where professional midwifery is well developed. Chile has the lowest rate (22.3/100,000) and has managed to develop both institutional and community professional midwifery. Midwifery, both as a specialty of nursing and as a direct entry profession, has made important contributions to maternal and infant health in the Americas over the last decade.
Conclusions: Maternal and perinatal mortality in the Americas is lower compared to other regions of the world, in particular the African region. Much effort is invested in maternal health care in the Americas, but in general, professional midwifery is not well developed. Traditional midwifery will continue to play an important role in several countries in the near future.