Volume 5, Issue 7, July – 2020 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Perceptions of Nurses Before Professional

Midwifery in the First Level of Health Care
Dora Gutiérrez Toledo1
Technical Secretary of the Inter-Agency Nursing Commission of the State of Chiapas
Chiapas State Health Institute
Tuxtla Gutiérrez, Chiapas, México

Ivett Reyes Guillén2 Bárbara Muñoz Alonso Reyes3

Faculty of Social Sciences Therapist TBE and Psychologist Professor
Autonomous University of Chiapas Public Health and Developmental Care Research Network,
San Cristobal de Las Casas, Chiapas, Mexico REINVESAD

Abstract:- Maternal death is a serious problem of global complications related to pregnancy or childbirth. In 2015,
public health, in many of their cases associated with 303,000 deaths of women were estimated during pregnancy
cultural factors and “uses and customs”, this in the and childbirth or related to them. Virtually all these deaths
different cultures where the problem arises. In Chiapas, occur in low-income countries and most of them could have
Mexico, the approach to traditional midwives represent been prevented. Since 1990, several sub-Saharan countries
a concomitant element with aggravated births and need have halved their maternal mortality. In other regions, such
the establishment of professionalization programs for as Asia and North Africa, progress has been even greater.
midwives. The objective of this study was to analyse the Between 1990 and 2015, the global MMR (i.e. the number
perceptions of nurses about the impact of professional of maternal deaths per 100,000 live births) fell by only
midwifery on the first level of care A cross-sectional 2.3% per year. However, from 2000 on, an acceleration of
investigation was conducted, showing n=100 this reduction was observed. In some countries, annual
participants. The results on the perceptions of nurses in reductions in maternal mortality between 2000 and 2010
the face of professional midwifery at the first level of exceeded 5.5% (WHO, 2018).
care are ambiguous, on the one hand, they comprise the
main objective of the program and express the According to the information published by the
motivation for the independent performance of prenatal Directorate-General for Epidemiology in relation to
consulting, consider that a high impact would be Maternal Deaths 2018, in Mexico the estimated Maternal
achieved in the contribution to the reduction of Mortality Ratio (RMM) is 30.2 deaths per 100 thousand
maternal death. However, their perception of the estimated births, representing a decrease of 11 percentage
strategy of boosting professional midwifery in the State points compared to the same date last year. The main
of Chiapas is not entirely positive since 28% regard it as causes of death are: Obstetric hemorrhage (23.2%),
an imposition, others as an irrelevant strategy and 6% Hypertensive disease, edema and proteinuria in pregnancy,
refer that these functions are the responsibility of those childbirth and postpartum (21.7%) abortion (8.7%). The
who hold the code of license in nursing and obstetrics. states reporting the highest number of deaths are Chiapas
Adding difficulties that limit the effective performance (77), Edo. From Mexico (73), Veracruz (38), Jalisco (36)
of comprehensive care to women in pregnancy, and Oaxaca (31). (Gob. Mex, 2018).
childbirth, and low risk postpartum, highlighting little
support from managers, lack of training, lack of inputs, Chiapas continues to occupy, unfortunately, the first
complications of the binomial and medical apathy. place in maternal mortality in Mexico. Because of this
emerging situation in which the State is located and in
Keywords:- Nursing, professional midwifery, perceptions. maternal care, we will talk specifically about professional
nurses and traditional midwives.
I. INTRODUCTION
While the profession in obstetric nursing is a
Maternal Death (MM) has been one of the most relatively recent field of study-practice in Mexico, this
meaningful public health problems within different compared to the development of midwives that has a long
societies and throughout the times. In Latin American history beginning with the ancestral practice of traditional
countries, geographical diversity, socioeconomic and midwives across the country, whose services not only
cultural, have been determinants of the lack of equity in constituted a necessary aid for the birth of women from
efforts aimed at the attention of this problem (Reyes- emerging times in the country , if not, a cultural element
Guillén and Leyva, 2014). inseparable from the rite of birth and accompaniment of the
mother.
According to data published by WHO on 16 February
2018, maternal mortality is unacceptably high, with
approximately 830 women dying worldwide from

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Volume 5, Issue 7, July – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
With the formation of the first nursing schools, In 2019 they established a second format "National
childbirth is seen as an element of public health and seeks Register of Nursing Staff Productivity Providing
to eradicate the elements potentially dangerous to the Professional Midwifery Services" that aims to record,
mother and newborn. However, this great advance in care unify, concentrate and analyze the activities of perinatal,
still has a reluctance for many communities in Mexico, due nursing and obstetrics specialist nurses, technical midwives
to the cultural burden that was established around or other non-medical staff in providing services in the
traditional midwives. That is why the strategy of training continuum of sexual health care , reproductive, maternal
professional midwifery, from nurses, is of high impact for and neonatal in first-level units and hospitals of the health
the achievement of the articulation between health services services of federal entities.
and the cultural elements surrounding the search for care by
women for monitoring and attention of the process of Although, these records promote greater control of
pregnancy, childbirth and postpartum. perinatal health services taking into account cultural
factors, their implementation in the State of Chiapas, has
Citing specifically nursing personnel, the Inter- caused various dilemmas in the role of nursing personnel
Agency Nursing Commission of the Ministry of Health who have the training of obstetrics or perinatology because
launched the "Obstetric Nursing Care Model" (2005). This according to the code that it holds, it must fulfill the
model aims to harness the potential of nursing staff, functions that correspond to it. However, others have been
especially the graduate in nursing and obstetrics and the motivated and encouraged by independent consulting at the
perinatal nursing specialist, in order to extend professional first level of care by providing low-risk prenatal
care coverage to pregnant women, improve the quality of consultations, without the specialist code.
care and thus contribute to solving the problems of
morbidity and maternal mortality in the country. The Professional midwifery offers us opportunities to
current model of obstetric care in Mexico has resulted in a improve the quality of care and coverage with equity access
high percentage (94%) institutional births (Gutiérrez et al to health services located in the most marginalized and
2012). vulnerable areas. This would be achieved by addressing
normal births in world-class health units and thus allowing
Public hospitals handle many normal deliveries with a hospitals to deal only with complicated cases (Fernández,
human resource shortfall to deal with obstetric 2018).
emergencies, resulting in a decrease in the quality of care.
Faced with this problem, there is the inclusion of Since the past decade, strengthening the role and
professional midwifery and obstetric nurses in the models participation of professional midwifery has been a central
of care to redistribute normal births to the primary level of component in WHO's special contribution to the Global
health. In this regard, there are successful experiences that Initiative for Safe Maternity, Reducing the Risks of
indicate the feasibility of carrying these interventions on a Pregnancy. It was launched in 2000, after the 10-year
larger scale. But in Mexico, it is not yet possible to identify Technical Consultation to review the safe maternity
ways to do this exercise in a formal and responsible manner initiative in Colombo, Sri Lanka, in 1997. This
(Macarthur Found, 2013). unprecedented global consultation worked hard to examine
effective interventions for better outcomes in pregnancy
By recounting the professionalizing strategies, since and childbirth. The conclusion was that without health
the Institute of Health (IESCH, 2019) the Permanent service providers with certain midwife skills and
Commission of Nursing has been implemented, in 2016, to competencies, especially life-saving skills, mother, and
address the topic of Strengthening the Practice of obstetric newborn health goals cannot be achieved (WHO, 2010).
and perinatal nurse, a project that is in charge of the
National Center for Gender Equity and Reproductive The quality of care provided during childbirth
Health and the Directorate-General for Quality and Health includes the technical and interpersonal competencies of
Education , and is instructed for Chiapas, which health personnel; but it also depends on the systemic
implements the filling of the Register Card of Nursing conditions of the service in which they work, and the
Personnel and Technical Midwives for the care of guarantee of safety, efficiency, equity, acceptability and
childbirth as well as the description of the activities it accessibility of the services.
carries out.
Despite this, to this day, neither traditional midwives
In 2017, they modify the formats by the National nor professionals have had the proper recognition, nor a
Center for Gender Equity and Health where they inform clearly defined space of action within the health system.
that the National Registry of Staff providing Midwifery The gap between the cultural and the current continuing
Services is intended to identify health professionals health care, but care in health facilities is increasingly
involved in professional midwifery in top-level units and totalitarian, creating a new challenge of organizing health
hospitals of the Health Services of federal entities , aiming services.
to improve the processes of registration, concentration and
analysis of information.

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Volume 5, Issue 7, July – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Currently, 96% of deliveries in Mexico are served in The results found in this research show a predominate
second-tier hospitals, this has led to the saturation of of female nurses (63%) and an age prevalence of 31 to 39
services, which do not always have sufficient staff or years (44%). Most of the staff interviewed are distributed in
material and financial resources to provide quality maternal Health Centers (94%) and only 6% are working in the field,
care. Excessive demand for services has led to situations of i.e. providing their services in health homes, which shows
mistreatment of women and their newborn, including cases poor health coverage to the most marginalized and
of obstetric violence, in addition the pressure has also led to vulnerable population.
the routine use of non-evidence-based practices, and to the
excessive medicalization of childbirth (Lucille, 2016). The predominant academic training is of graduates in
nursing with 56%, general nurses technical 36% and only
For the above and the interest that research deserves in 7% are licensed in nursing and obstetrics. This tells us that
the area, which allows the contribution to reduce cases of there is still a large gap in achieving the skills needed to
maternal death, this document sets out the results of a study effectively contribute to reducing maternal morbidity and
conducted in Chiapas, Mexico, whose main objective was mortality.
to analyze the perceptions of nurses regarding the impact of
professional midwifery on the first level of care. Regarding the perception of the need for training and
motivation of the nursing professional in the face of the
II. METHOD strategy of the professional midwifery, 69% consider him a
high priority and very high, however; its perception of the
This research was carried out during 2019, in Chiapas, strategy of boosting professional midwifery, only 28%
Mexico. It is of a cross-cutting, qualitative type, that as the consider it mandatory, 6% as non-important and another
main tool for obtaining the information used the structured 6% refers that this strategy should only apply to nurses who
interview, applying a perception questionnaire to nurses have the Employment Code of Bachelor of Nursing and
who are working in the first level of care and who carries Obstetrics.
out activities of professional midwifery.
This perception checks the theory of Neisser (1979)
Population: 2800 nurses of the first level of care that tells us that perception is an active-constructive process
distributed in the 10 Health Jurisdictions of the State of in which the recipient, before processing the new
Chiapas according to the Federal Platform of the Ministry information and with the data archived in his
of Health of the Human Resources Management System in consciousness, builds an anticipatory informational scheme,
Nursing. which allows him to contrast the stimulus and accept or
reject it as indicated or not to what is proposed by the
Sample: 100 nurses from the first level of care scheme.
participating in the Professional Midwifery Registration
Format located in different regions of the state of Chiapas In this regard, it is essential to consider that, as a
(San Cristobal de las Casas, Villaflores, Palenque, support for vocational nursing training, it is necessary not
Tapachula and Motozintla). to neglect the ethical aspects of this discipline, since, in the
21st century, it would seem that human duty is being
The following sources were used for data collection: carried out by the labor code rather than by ethics itself.
 Human Resources Management System in Nursing Nursing arises from this ethical and moral condition in the
period May 2019 Federal platform, for consultation of face of the need for care, which means that regardless of the
the number of nursing resources in the first level of labor code that nurses have, it must be able to provide care
care. that guarantees the well-being and safety of people,
 Professional Midwifery Registration Formats period preserving their health.
June 2019 Concentrate of the State of Chiapas.
 Interview questionnaires for perceptions applied to Other relevant outcomes are the lack of training on
nursing staff who are working in health units of the first topics related to comprehensive care for women in
level of care and who were selected in the pregnancy, childbirth and low-risk postpartum; these same
representative sample. issues are those that are part of the proposals expressed by
the nurses to strengthen the professional midwifery in the
III. DISSCUTION first level of care. Among the topics mentioned as
necessary to impart to train nurses are:
The population under study consisted of a  Labor care (66%)
representative sample of 100 elements of the nursing staff  Low-risk pregnancy and care (59%)
that are working in health units of the first level of care  Postpartum care (18%)
dependent on the health jurisdictions San Cristóbal de las  Obstetric emergency (14%)
Casas, Villaflores, Chiapas, Palenque, Tapachula de
Córdova and Ordoñez, Tonalá and Motozintla of the
Institute of Health of the State of Chiapas, Mexico.

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Volume 5, Issue 7, July – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
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It is essential to consider the training and motivation
of nurses as an essential part of strategies to influence the
decline in maternal death. In countries such as Mexico, this
need is even greater, due to the difficulties that hinder the
performance of the health professional in all areas; but that
are delicately slowing down the performance of nurses.

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