Non-physician providers of obstetric care in Mexico: Perspectives of physicians, obstetric nurses and professional midwives (Human Resources for Health)

Background: In Mexico 87% of births are attended by physicians. However, the decline in the nationalmaternal mortality rate has been slower than expected. The Mexican Ministry of Health`s2009 strategy to reduce maternal mortality gives a role to two non-physician models thatmeet criteria for skilled attendants: obstetric nurses and professional midwives. This studycompares and contrasts these two provider types with the medical model, analyzingperspectives on their respective training, scope of practice, and also their perception and/orexperiences with integration into the public system as skilled birth attendants.MethodologyThis paper synthesizes qualitative research that was obtained as a component of thequantitative and qualitative study that evaluated three models of obstetric care: professionalmidwives (PM), obstetric nurses (ON) and general physicians (GP). A total of 27 individualinterviews using a semi-structured guide were carried out with PMs, ONs, GPs andspecialists. Interviews were transcribed following the principles of grounded theory, codesand categories were created as they emerged from the data. We analyzed data in ATLAS.ti. Results: All provider types interviewed expressed confidence in their professional training andacknowledge that both professional midwives and obstetric nurses have the necessary skillsand knowledge to care for women during normal pregnancy and childbirth. The three types ofproviders recognize limits to their practice, namely in the area of managing complications.We found differences in how each type of practitioner perceived the concept and process ofbirth and their role in this process. The barriers to incorporation as a model to attend birthfaced by PMs and ONs are at the individual, hospital and system level. GPs question theirability and training to handle deliveries, in particular those that become complicated, and theprofessional midwifery model particularly as it relates to a clinical setting, is also questioned. Conclusions: Hospitals in the Mexican public health sector have a heavy obstetric workload; physicianscarry the additional burden of non-obstetric cases. The incorporation of a non- physicianmodel at the primary health center level to attend low-risk, normal deliveries wouldcontribute to the reduction of non-necessary referrals. There is also a role for these providersat the hospital level.