ArticleBMJ quality & safety2020
Obstetric care navigation: results of a quality improvement project to provide accompaniment to women for facility-based maternity care in rural Guatemala.
Article in BMJ quality & safety, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
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Who cites it
20 citing papers in PubMed.
- Trial
- Safe birth in cultural safety in southern Mexico: a pragmatic non-inferiority cluster-randomised controlled trial.BMC pregnancy and childbirth · 2022Trial
- Observational Cross-Sectional Study with Guatemalan Lay Midwives About Acupressure Use for Preeclampsia.Medical acupuncture · 2026Article
- Navigating strategies for intercultural maternal and newborn care in Latin America and the Caribbean: a scoping review.Health promotion international · 2026Article
- Re-establishing control limits in statistical process control analyses: the stable shift algorithm.BMJ quality & safety · 2026Article
- Integrating Indigenous Maya practices and digital health tools to improve outcomes for Indigenous newborns in Guatemala: a community-based initiative.Global health action · 2025Article
- Ninety-one years of midwifery continuity of care in low and middle-income countries: a scoping review.BMC health services research · 2025Article
- Article
- Traditional Midwifery Contribution to Safe Birth in Cultural Safety: Narrative Evaluation of an Intervention in Guerrero, Mexico.Community health equity research & policy · 2024Article
- A biosocial analysis of perinatal and late neonatal mortality among Indigenous Maya Kaqchikel communities in Tecpán, Guatemala: a mixed-methods study.BMJ global health · 2024Article
- Patient navigation in women's health care for maternal health and noncancerous gynecologic conditions: a scoping review.Women's health nursing (Seoul, Korea) · 2024Article
- Cultural brokering in pregnancy care: A critical review.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2023Review
- From quality improvement to equality improvement projects: A scoping review and framework.iScience · 2023Article
- Examining the Role of Quality of Institutionalized Healthcare on Maternal Mortality in the Dominican Republic.International journal of environmental research and public health · 2023Article
- Self-reported continuity and coordination of antenatal care and its association with obstetric near miss in Uasin Gishu county, Kenya.African journal of primary health care & family medicine · 2023Article
- An exploratory study of client and provider experience and perceptions of facility-based childbirth care in Quiché, Guatemala.BMC health services research · 2022Article
- Improving the experience of facility-based delivery for vulnerable women through obstetric care navigation: a qualitative evaluation.BMC pregnancy and childbirth · 2021Article
- Blood pressure in a pregnant, rural Guatemalan population: Results from a quality improvement database.European journal of obstetrics, gynecology, and reproductive biology · 2021Article
- Out-of-Pocket Costs for Facility-Based Obstetrical Care in Rural Guatemala.Annals of global health · 2021Article
- Using the Lived Experience From Traditional Midwives in Remote Guatemala to Guide Improvement in Maternal Outcomes.Journal of midwifery & women's healthArticle
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMany maternal and perinatal deaths in low-resource settings are preventable. Inadequate access to timely, quality care in maternity facilities drives poor outcomes, especially where women deliver at home with traditional birth attendants (TBA). Yet few solutions exist to support TBA-initiated referrals or address reasons patients frequently refuse facility care, such as disrespectful and abusive treatment. We hypothesised that deploying accompaniers-obstetric care navigators (OCN)-trained to provide integrated patient support would facilitate referrals from TBAs to public hospitals.
methodsThis project built on an existing collaboration with 41 TBAs who serve indigenous Maya villages in Guatemala's Western Highlands, which provided baseline data for comparison. When TBAs detected pregnancy complications, families were offered OCN referral support. Implementation was guided by bimonthly meetings of the interdisciplinary quality improvement team where the OCN role was iteratively tailored. The primary process outcomes were referral volume, proportion of births receiving facility referral, and referral success rate, which were analysed using statistical process control methods.
resultsOver the 12-month pilot, TBAs attended 847 births. The median referral volume rose from 14 to 27.5, meeting criteria for special cause variation, without a decline in success rate. The proportion of births receiving facility-level care increased from 24±6% to 62±20% after OCN implementation. Hypertensive disorders of pregnancy and prolonged labour were the most common referral indications. The OCN role evolved to include a number of tasks, such as expediting emergency transportation and providing doula-like labour support.
conclusionsOCN accompaniment increased the proportion of births under TBA care that received facility-level obstetric care. Results from this of obstetric care navigation suggest it is a feasible, patient-centred intervention to improve maternity care.
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