Quality Care for Mothers and Newborns at Birth in Mexico

*Bonifacio Caballero Noguéz, Roberto Aguli Ruíz Rosas and Ernesto Calderon Cisneros*

#### **Abstract**

Estimates of the United Nations (UN) consider that in the world 2.5 million neonates died in the last year from preventable causes such as prematurity, complications during childbirth, and infections. Some died because the care they received was of poor quality. The most striking is that 1.7 million newborns could be saved by improving access to quality care for all pregnant women in humanitarian settings, especially those considered as low- and middle-income countries by the World Bank. Neonatal mortality can be considered as a sensitive indicator of the well-being of a population, the degree of development of a country, as well as health conditions in the mother's environment and the good quality of prenatal and intrapartum care. This will seek the achievement of the Sustainable Development Goals (SDGs) of the United Nations, through universal health coverage (UHC), by 2030. The medical advances that obstetrics has had around history show the interest and importance for the health sector of all countries in the world, the attention of women, especially during the reproductive stage in which it is located at stake the life and health of the human capital of the future. Today, obstetrics is the health science recognized worldwide because it addresses the health of women during the preconception, conception, prenatal, childbirth, postnatal, and postconception stages, as well as the newborn. Every day more progress is made, not only in the increasingly early diagnosis, but also in the care, attention during the months of gestation, and studies and tests to be carried out to have a greater certainty of what happens inside the uterus-definitely, we are going forward. But the latter is not available to all pregnant women, or in all regions of Mexico, because of the asymmetry in the structure, with imbalance in qualified human resources and technology that detract from this quality of care that is intended. Therefore, we are still reporting preventable maternal deaths and preterm infants, and the interest of this chapter is to show the need, as referred by the World Health Organization (WHO), to improve the quality of care with qualified personnel: obstetricians for women and neonatologists or pediatricians for newborn care.

**Keywords:** childbirth, birth care, newborn, prematurity, sustainable development goals, Mexico

#### **1. Introduction**

"There is no concept of normalcy during labour and childbirth." Because complications that increase morbidity and mortality of the mother-child binomial may occur during the process.

In 2015, the United Nations Organization (UN) established Agenda 2030 for Sustainable Development Goals (SDGs) as an action plan for people, where it highlights the importance of measures to ensure maternal and child health.

Under the SDGs, specifically, SDG 3 sets targets for 2030 to reduce maternal mortality rates below 70 per 100,000 live births and neonatal mortality for all countries to no more than 12 per 1000 live births [1].

Achieving this will require effective strategies and targeted actions, as well as monitoring progress against basic indicators of maternal and child health (MCH). In this regard, one of the key indicators, which is explicitly adopted in the SDGs and the Global Strategy for Women's, Children's and Adolescents' Health 2016–2030, is the proportion of births attended by skilled health personnel [2].

This approach is aimed at preventing the highest number of preventable deaths, including mothers, fetuses, and newborns.

#### **2. Preterm birth is a syndrome**

Premature childbirth should be considered a syndrome by the multiple processes that trigger it, some pathological and others still unknown [3].

In essence, both the beginning of term labor and premature delivery share a similar clinical process: increased uterine contractility, cervical dilation, and rupture of the chorioamniotic membranes [3].

However, despite efforts to reduce these risk factors, the rate of preterm births continues to rise.

Intra-amniotic infection has been causally associated with premature delivery [4].

One third of newborns have the history that their mother has, which is an intra-amniotic infection from the association of isolated germs in the amniotic fluid and the similarity of those found in the genital tract. Similarly, bacteria have been found involved in periodontal pathology, suggesting the possibility of hematogenous dissemination and transplacental passage, although the ascending pathway is considered the most frequent route of infection. Since bacteria have been found in the circulation of premature patients, it suggests that there is a systemic inflammatory response (infection/inflammation) [5, 6].

The microbiological diagnosis of an intra-amniotic infection has been based on the use of culture techniques (adequate nutritional and environmental conditions) with the growth of bacteria obtained from the amniotic fluid.

The theory that describes the biofilm process described in 1978 states that bacteria grow in communities called "biofilms," which generally adhere to surfaces, and that most bacteria grow in biofilms enclosed within a matrix, so they differ from their isolated forms observed in Gram staining tests of biological fluids or pure cultures (planktonics, so named for their similar shape to marine plankton) [7].

Biofilms are now recognized as playing an important role in human diseases.

Infections outside the genitourinary area such as periodontitis, otitis media, endocarditis, and many others where there is a device (prosthetic valves or catheters) involve bacterial biofilms [8].

In view of this possibility, molecular microbiological techniques have recently been used to detect microorganisms in the amniotic cavity [9].

On the other hand, about 25% of premature newborns are born as a result of a medical intervention to interrupt pregnancy when complications such as preeclampsia or maternal comorbidity occurs (heart disease and systemic lupus erythematosus, among others) [10].

Approximately 50% of all premature births are due to unknown causes or multifactorial processes that cause the uterus to move from a state of inactivity to one

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*Quality Care for Mothers and Newborns at Birth in Mexico*

of active contractions. In other words spontaneous premature delivery of unknown etiology can be initiated in up to half of the cases by multiple causes (gene-gene and gene-environmental interactions, such as smoking cigarettes, short cervix, young maternal age, assisted reproduction technology (overdistension of the uterus caused by multiple pregnancy), socioeconomic and cultural aspects that condition

It is estimated that approximately 140 million births occur annually in the world,

However, in addition to the possible complications that can occur during labor, there is the problem related to premature delivery that occurs between 5 and 18% of pregnancies and is one of the main causes of morbidity and mortality in the neonatal stage. Premature newborns are at increased risk of short-term complications attributed to organic immaturity, especially at the central nervous system level with neurodevelopmental disorders such as cerebral palsy and intellectual, visual, and

Therein lies the importance for the prevention and treatment of premature labor

It is estimated that approximately 15 million births will be premature (11%), half

In recent decades, advances in neonatal care have been significant and there are reports of survival of newborns with gestational age from 22 weeks (22–26 weeks, a

In particular, pregnant women considered to be at high risk of periviable childbirth have been treated in tertiary care hospitals with neonatal intensive care units

For this reason, reducing the rate of premature births requires a better under-

The mechanism that determines the beginning of the term or preterm birth is

Morbidity, early mortality, and the presence of lifelong sequelae of a premature

They die because of lack of adequate prenatal care or medical care with infrastructure and qualified personnel. In middle-income countries, newborns born between 28 and 33 weeks of gestation have improved the prognosis of survival but will have almost twice as many disability problems as those from high-income countries. In high-income countries, more than 95% survive with lower morbidity

Alternatives that can be applied, safe and available in all countries to prevent premature delivery, mainly before 34 weeks of gestation, should therefore be

Improvement in health care for women, children, and adolescents is included in the SDGs, which aim to ensure that the mother-children not only survive the

In recent years, premature childbirth has increased globally, becoming a problem in obstetric care and one of the main causes of infant death worldwide, a serious problem for health systems. Premature birth accounts for more than 85% of

newborn will depend to a large extent on the country where he or she is born. In countries considered low income, disability problems are rare, particularly in newborns under 28 weeks of pregnancy or those with some pathology [24].

all complications and perinatal deaths during the infant stage [23].

in women without risk factors or comorbidity to present complications for both

late or nonprenatal care, and previous premature delivery) [11–15].

them and their babies, at the beginning and during labor [16].

and thus to remain under the goals of the SDGs [18].

period commonly considered "periviable").

standing of the mechanisms responsible.

not known, although it is considered multifactorial.

of which will be due to unknown or unclear causes [19–21].

*DOI: http://dx.doi.org/10.5772/intechopen.89639*

**3. World situation**

auditory disabilities [17].

(NICUs) level 3 [22].

and sequelae [25].

investigated [26].

of active contractions. In other words spontaneous premature delivery of unknown etiology can be initiated in up to half of the cases by multiple causes (gene-gene and gene-environmental interactions, such as smoking cigarettes, short cervix, young maternal age, assisted reproduction technology (overdistension of the uterus caused by multiple pregnancy), socioeconomic and cultural aspects that condition late or nonprenatal care, and previous premature delivery) [11–15].
