Professional midwifery in Guatemala: A qualitative exploration of perceptions, attitudes and expectations among stakeholders.
Professional midwifery in Guatemala: A qualitative exploration of perceptions, attitudes and expectations among stakeholders.
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危地马拉的专业助产士：对利益相关者的看法、态度和期望的定性探索。
DOI：
10.1016/j.socscimed.2017.05.005
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Walker,Dilys
中科院分区：
文献类型：
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作者：
Summer,Anna;Guendelman,Sylvia;Kestler,Edgar;Walker,Dilys
背景尽管建议妇女由熟练的助产士(SBA)分娩，但危地马拉70%的分娩是在卫生机构以外的非正规培训的传统助产士(TBA)的帮助下进行的。为了增加农村和土著社区的SBA，一所由政府认证的专业助产学校计划于2017年开学。借鉴菲尔比关于专业助产成功融入卫生系统的障碍的模型，本文旨在找出危地马拉重新引入专业助产面临的威胁和促进者。方法通过对危地马拉市6个卫生中心的32名医生、护士和TBA以及危地马拉市的关键决策者和职业助产士(PM)的深入访谈，阐明对专业助产的看法、态度和期望。我们在Atlas.ti中进行了开放式和轴向编码，并将参与者的态度、认知和期望与国家助产专业愿景进行了规范性比较，以及学科亚组内部和跨学科亚组之间的相对比较。然而，当为他们定义专业助产时，他们表示愿意与PM合作，将他们视为所需的人力资源，有助于提供跨文化护理并加强与TBA的设施关系。一些利益相关者预计，由于供应商的地盘问题，对PM的抵制。所有群体在期望上的显著差异包括对PM的监督和由PM的监督，以及PM在监测妇女和在社区中与TBA一起进行分娩方面的角色。结论促进职业助产士成功的因素包括国家政治意愿、利益相关者的统一愿景以及改善跨文化护理的潜力。障碍大多是专业性质的，包括PM自主实践的障碍、等级挑战和地盘问题。专业助产士要想成功地减少危地马拉的产妇保健差距，就需要有一份具体的路线图来解决已查明的障碍。
BackgroundDespite 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.MethodsTo 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.ResultsUnprompted, 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.ConclusionsFacilitators 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.