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

### **5.1 Description of the condition**

*Maternal and Child Health Matters Around the World*

tion of the newborn and the mother after delivery [29].

potential in health [27, 28].

**4. Friendly obstetric care**

of medicalization [30, 31].

models [32, 33].

procedures.

the binomial [34–40].

overall cost of medical services [41].

prenatal or postpartum care strategies [26].

the goal of all doctors, especially obstetricians [44].

complications that may occur during childbirth but also achieve the maximum

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

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

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

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

The gap in maternal and perinatal deaths is disproportionate between low- and

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

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

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

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

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

This is used as a strategy to reduce maternal morbidity by explicitly and directly

the percentage of births per cesarean section should not exceed 15% [43].

middle-income countries compared to high-income countries [42].

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 resuscita-

**94**

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, and birth of the baby.

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 rather than at home.

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 rather than the norm.

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 individual support for women during childbirth [46].

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 interculturality and privacy [47].

WHO recommends the presence of a companion of choice of woman during childbirth [48, 49].

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 overall cost of medical services [41].

In hospitals in middle-income countries, especially in Latin America, women in labor are without support and under a model of medicalized care [50].

This model of care is carried out mainly in urban areas, where more than 70% of the population currently resides.

## **6. Obstetric care in Mexico**

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 puerperium has a greater impact.

In the period from 2004 to 2009, 8.6% of pregnancies ended in abortion, making it the 5th leading cause of maternal deaths.

In the last 12 years, the medicalized model has become a public health problem since approximately 50.3% of the births by women aged 20–49 years were obtained by cesarean section. Only 25.7% had emergency medical indication. The highest number is in private care institutions with 60.4% of the total [53–56].

Although efforts are being made to overemphasize the care of labor in childbirth and to reduce the percentage of cesarean sections to the figures recommended by WHO (15%), progress in this regard is slow [57, 58].

If prenatal care does not meet quality standards, the chances of a large number of pregnant women ending up with premature delivery are high. It is where cultural factors and social and economic conditions will influence its presence.

The institution where the authors work Mexican Social Security Institute (Instituto Mexicano del Seguro Social, IMSS) provides social security to more than 50% of the Mexican population.

**Figure 1** shows the trend of the maternal mortality ratio recorded in the last 17 years in Mexico (upper line). In the lower line of the graph is the reason that corresponds to the IMSS during the same period.

The safety approach includes the obstetric skills that the first contact staff must have for identifying obstetric risks during pregnancy, as well as for delivery care in accordance with the recommendations of WHO and for the management and referral of complications of WHO. With regard to the level of the hospital, it should have all the competences, conditions, and interinstitutional agreements, in order to be able to identify, attend to, and resolve obstetric complications and emergencies in a timely manner, within a strategy of real functional flow networks in health services, to ensure timely care for women in labor, with or without complications, under the "zero rejection" initiative [59].

Each country should develop strategies to improve access to care, in line with different health care systems. In Mexico, there are several social security systems (public) to try to guarantee the health of its population, leaving a very low percentage of the population without social security coverage and those who have the possibility of being cared for in private institutions [60].

In Mexico, the "Comprehensive Interinstitutional Partnership Agreement for Obstetric Emergencies" was developed to provide immediate medical care to women in the severe puerperal period, with an emergency that endangers their lives, where care for newborns is also included.

#### **Figure 1.**

*Maternal mortality ratio in Mexico (2000–2017). \*Source: Secretaria de Salud and Instituto Mexicano del Seguro Social.*

**97**

**Figure 2.**

**Table 1.**

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

discharges, in the period from July 2018 to June 2019.

*The numbers from March to June 2019 were calculated. Source: IMSS.*

*A premature newborn treated at IMSS, from the "early intervention" program.*

*The 10 main hospital discharge in the Mexican Social Security Institute (July 2018 to June 2019).*

This agreement is a written agreement between the health institutions that set out the general guidelines for the medical units of the SS of the Institute for Social Security and Services of State Workers (ISSSTE) and the Mexican Social Security Institute (IMSS), with capacity for complex obstetric care by providing these services through immediate response teams, to women with an obstetric emergency. **Table 1** shows the top 10 causes of hospital discharge in IMSS. It is noted that obstetric care (pregnancy, childbirth, and puerperium), while not being an illness, was the first reason for hospital discharge, representing 25% (517,800) of total

**Causes Discharges**

 Pregnancy, childbirth, and the puerperium 517.8 25 Injuries and poisonings 164.8 8 Heart diseases 97.4 5 Malignant tumors 91.4 4 Cholelithiasis and cholecystitis 85.6 4 Renal insufficiency 85.0 4 Conditions originating in the perinatal period 72.3 3 Diabetes mellitus 55.5 3 Hernias 41.2 2 Pneumonia and influenza 40.7 2 **Sum of the 10 main causes 1251.0 59 Total 2112.3 100**

**Thousands %**

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

*Quality Care for Mothers and Newborns at Birth in Mexico DOI: http://dx.doi.org/10.5772/intechopen.89639*

This agreement is a written agreement between the health institutions that set out the general guidelines for the medical units of the SS of the Institute for Social Security and Services of State Workers (ISSSTE) and the Mexican Social Security Institute (IMSS), with capacity for complex obstetric care by providing these services through immediate response teams, to women with an obstetric emergency.

**Table 1** shows the top 10 causes of hospital discharge in IMSS. It is noted that obstetric care (pregnancy, childbirth, and puerperium), while not being an illness, was the first reason for hospital discharge, representing 25% (517,800) of total discharges, in the period from July 2018 to June 2019.


#### **Table 1.**

*Maternal and Child Health Matters Around the World*

it the 5th leading cause of maternal deaths.

50% of the Mexican population.

WHO (15%), progress in this regard is slow [57, 58].

corresponds to the IMSS during the same period.

under the "zero rejection" initiative [59].

possibility of being cared for in private institutions [60].

lives, where care for newborns is also included.

In the period from 2004 to 2009, 8.6% of pregnancies ended in abortion, making

In the last 12 years, the medicalized model has become a public health problem since approximately 50.3% of the births by women aged 20–49 years were obtained by cesarean section. Only 25.7% had emergency medical indication. The highest

Although efforts are being made to overemphasize the care of labor in childbirth and to reduce the percentage of cesarean sections to the figures recommended by

If prenatal care does not meet quality standards, the chances of a large number of pregnant women ending up with premature delivery are high. It is where cultural

The institution where the authors work Mexican Social Security Institute (Instituto Mexicano del Seguro Social, IMSS) provides social security to more than

**Figure 1** shows the trend of the maternal mortality ratio recorded in the last 17 years in Mexico (upper line). In the lower line of the graph is the reason that

The safety approach includes the obstetric skills that the first contact staff must have for identifying obstetric risks during pregnancy, as well as for delivery care in accordance with the recommendations of WHO and for the management and referral of complications of WHO. With regard to the level of the hospital, it should have all the competences, conditions, and interinstitutional agreements, in order to be able to identify, attend to, and resolve obstetric complications and emergencies in a timely manner, within a strategy of real functional flow networks in health services, to ensure timely care for women in labor, with or without complications,

Each country should develop strategies to improve access to care, in line with different health care systems. In Mexico, there are several social security systems (public) to try to guarantee the health of its population, leaving a very low percentage of the population without social security coverage and those who have the

In Mexico, the "Comprehensive Interinstitutional Partnership Agreement for Obstetric Emergencies" was developed to provide immediate medical care to women in the severe puerperal period, with an emergency that endangers their

*Maternal mortality ratio in Mexico (2000–2017). \*Source: Secretaria de Salud and Instituto Mexicano del* 

number is in private care institutions with 60.4% of the total [53–56].

factors and social and economic conditions will influence its presence.

**96**

**Figure 1.**

*Seguro Social.*

*The 10 main hospital discharge in the Mexican Social Security Institute (July 2018 to June 2019).*

#### **Figure 2.**

*A premature newborn treated at IMSS, from the "early intervention" program.*

**Figure 3.** *A premature newborn treated in IMSS close to his hospital discharge.*

#### **Figure 4.**

*The economic cost and technological equipment required in the care of the premature newborn.*

The IMSS serves almost 50% of all public sector births in the country. In 2017, 425,516 births were registered; of these, 9.8% (41,664) were premature under 37 weeks of gestational age and 7320 (1.7%) weighed less than 1500 g. In **Figures 2**–**4**, we show preterm newborns treated in IMSS.
