**3. World situation**

*Maternal and Child Health Matters Around the World*

countries to no more than 12 per 1000 live births [1].

including mothers, fetuses, and newborns.

rupture of the chorioamniotic membranes [3].

tory response (infection/inflammation) [5, 6].

eters) involve bacterial biofilms [8].

erythematosus, among others) [10].

with the growth of bacteria obtained from the amniotic fluid.

been used to detect microorganisms in the amniotic cavity [9].

**2. Preterm birth is a syndrome**

continues to rise.

the proportion of births attended by skilled health personnel [2].

cesses that trigger it, some pathological and others still unknown [3].

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

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

This approach is aimed at preventing the highest number of preventable deaths,

Premature childbirth should be considered a syndrome by the multiple pro-

In essence, both the beginning of term labor and premature delivery share a similar clinical process: increased uterine contractility, cervical dilation, and

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

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 inflamma-

The microbiological diagnosis of an intra-amniotic infection has been based on the use of culture techniques (adequate nutritional and environmental conditions)

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 cath-

In view of this possibility, molecular microbiological techniques have recently

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

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

**92**

It is estimated that approximately 140 million births occur annually in the world, in women without risk factors or comorbidity to present complications for both them and their babies, at the beginning and during labor [16].

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 auditory disabilities [17].

Therein lies the importance for the prevention and treatment of premature labor and thus to remain under the goals of the SDGs [18].

It is estimated that approximately 15 million births will be premature (11%), half of which will be due to unknown or unclear causes [19–21].

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 period commonly considered "periviable").

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 (NICUs) level 3 [22].

For this reason, reducing the rate of premature births requires a better understanding of the mechanisms responsible.

The mechanism that determines the beginning of the term or preterm birth is not known, although it is considered multifactorial.

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

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

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 and sequelae [25].

Alternatives that can be applied, safe and available in all countries to prevent premature delivery, mainly before 34 weeks of gestation, should therefore be investigated [26].

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

complications that may occur during childbirth but also achieve the maximum potential in health [27, 28].

It is important to emphasize that public health policies implemented to protect the binomial do not have to be specific; they must guarantee the quality of care, because there are differences in the world related to the infrastructure and quantity of human resources in the care services that are available for each country or region. And, they include the care of labor, labor, expulsion period, delivery, and resuscitation of the newborn and the mother after delivery [29].

## **4. Friendly obstetric care**

Historically, birth was considered a natural process imbued with a strong cultural and social context, before its care and care by medical personnel was initiated, with what was modified the roles where the mother and the newborn had the leading role, becoming an "impersonal" process and often alien to their sociocultural condition, pathologizing pregnancy and especially labor, with abuse at times of medicalization [30, 31].

It is also important not only to identify but also to eradicate cultural barriers that hinder access to health services, because of the cultural and economic diversity that can exist among the population. In many countries, traditional and professional midwifery has emerged as an alternative to unconventional therapeutic models [32, 33].

In recent decades, a number of practices relating to labor have been increasingly developed with the aim of initiating to accelerate, finish, regulate, or monitor what should be considered a physiological process in order to achieve better results for the binomial [34–40].

While these have contributed to decreasing maternal and perinatal morbimortality, in countries with low and medium incomes, they promote the use of unnecessary interventions and neglect the emotional needs of pregnant women, leaving the mother to play a secondary role and contributing to the increase in the overall cost of medical services [41].

The gap in maternal and perinatal deaths is disproportionate between low- and middle-income countries compared to high-income countries [42].

It can also generate a perception, in women, of being excluded during their care by not having a participation in decision-making in the performance of some procedures.

Therefore, improving the quality of care around the time of birth, especially in low- and medium-income countries, has been identified as the most striking strategy for reducing fetal deaths and maternal and neonatal deaths, compared to prenatal or postpartum care strategies [26].

Mexico ranks fourth in the world (after China, Brazil, and the United States) in the use of cesarean sections without medical indication (38.5% of births); this percentage is above the World Health Organization (WHO) recommendation that the percentage of births per cesarean section should not exceed 15% [43].

WHO has proposed the model of friendly obstetric care. The pleasant and human experience of childbirth must nowadays be the desire of all women and also the goal of all doctors, especially obstetricians [44].

This is used as a strategy to reduce maternal morbidity by explicitly and directly taking back the emotional needs and values of women and their families in the care of pregnancy and birth and during puerperium, emphasizing the intercultural aspects that recognize the diversity that exists among women, and in order

**95**

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

**5. "Support" for women during childbirth**

individual support for women during childbirth [46].

**5.1 Description of the condition**

and birth of the baby.

rather than at home.

rather than the norm.

turality and privacy [47].

overall cost of medical services [41].

the population currently resides.

**6. Obstetric care in Mexico**

puerperium has a greater impact.

childbirth [48, 49].

to eradicate cultural barriers by promoting the right to scientific health care by health professionals who have the best obstetric skills, focusing on pregnant women empowering them to make decisions and returning them to their leading role [45].

From the dawn of history and between different cultures, women were cared for and supported by other women during labor and childbirth, which has been called "continuous support," excluding the "man" during practically the labor, delivery,

However, since the middle of the nineteenth century, in many countries, especially in Europe, a large percentage of pregnant women had their births in hospital

Until Ignaz Philipp Semmelweis (Allgemeines Krankenhaus der Stadt Wien) in 1847 proposed to wash his hands, as the puerperal fever caused the death of 10–35%, which was three to five times higher than those attended by "midwives" is the word. Consequently, continued support during childbirth became the exception

At the beginning of this century, the experiences of childbirth in women (especially in high-, middle-, and low-income countries) have led to the resumption of

Recent publications show that many women benefit from and value the presence of a support person during childbirth, which provides them with psychological, physical, emotional, informative, and practical support, respecting their intercul-

WHO recommends the presence of a companion of choice of woman during

In this same perspective, the aim is to "oversell" the care of low-risk childbirth. It is described in the literature as a highly medicalized care model that promotes the use of unnecessary interventions, neglects the emotional needs of pregnant women, promotes cesarean section intervention, and contributes to the increase in the

In hospitals in middle-income countries, especially in Latin America, women in

This model of care is carried out mainly in urban areas, where more than 70% of

In Mexico, more than 90% of women living in large cities have their births in hospitals, with a high number of unnecessary practices of little scientific value, such as trichotomy, amnesty, indiscriminate use of ocytocytics, episiotomies, and cesarean sections, indicators of a high level of medicalization [34, 38, 39, 41, 51]. The ratios of maternal mortality in countries such as Mexico in 2018 were 34 cases per 100,000 live births, with variations among the different federal entities, suggesting that many of the causes of maternal mortality are preventable [52]. In teenage girls, the risk of complications during pregnancy, childbirth, or

labor are without support and under a model of medicalized care [50].

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

to eradicate cultural barriers by promoting the right to scientific health care by health professionals who have the best obstetric skills, focusing on pregnant women empowering them to make decisions and returning them to their leading role [45].
