Maternal Waiting Home Key to Safe Childbirth in Chiapas

It seemed like Arinda Roblero had been waiting forever to see her baby’s face. The single mother wasn’t sure when she was due, but estimated it was soon. She visited her clinic in Capitán, Chiapas, and the doctors there recommended she travel with them to Jaltenango, where she could get an ultrasound through Compaňeros En Salud, as Partners In Health is known in Mexico.

It’s a good thing Roblero did. She learned that her amniotic fluid level was low, and PIH staff recommended she stay in a maternal waiting home an hour away in Revolución Mexicana, where professional midwife Carolina Menchú could closely monitor her. The next day, another ultrasound revealed her fluid level had dipped into the danger zone.

Menchú spoke with obstetricians in the hospital located just behind the home and got Roblero scheduled for a cesarean section the following morning. Within hours, the new mother was cradling her daughter in her arms.

Although tired, Roblero said she felt good: “I’m happy, because now I’m a mom.”

Roblero and her daughter are among a growing number of success stories coming from the Unidad de Parto Humanizado, or Humane Birthing Center, in Revolución Mexicana. PIH is partnering with the Ministry of Health at this maternal waiting home and birth center to pilot a program that promotes culturally appropriate and respectful births attended by trained professionals. The 10-bed facility sits directly behind a hospital staffed with physicians who can attend to complicated deliveries.

The exterior of the Humane Birthing Center, located directly behind the hospital in Revolución Mexicana.

The facility will be fully staffed and equipped by August, yet Menchú has already attended 75 births since PIH started supporting the facility in August 2015. PIH’s ultimate goal is to prevent tragedies leading to the death of a mother or newborn.

Within five communities where PIH operates clinics in rural Chiapas, 60 percent of women surveyed said they delivered at home under the care of local traditional birth attendants, said Dr. Andrea Reyes, PIH’s maternal health program coordinator in Mexico. That percentage falls into the single digits in nearly every other part of the country. When complications arise, home birth can lead to life-threatening situations for mothers and newborns. So it’s possibly no surprise that Chiapas also has the second highest maternal mortality rate in Mexico, with 68 deaths for every 100,000 deliveries compared to 39 per 100,000 nationwide in 2014, according to the United Nations Millennium Development Goals.

Women living in remote communities of the Sierra Madre, where donkeys are more numerous than cars, stand the highest risk. Should a delivery turn too complicated for local birth attendants, a woman’s family scrambles to get her down the mountain to the nearest hospital, sometimes five hours by car.

“If a woman has a profuse hemorrhage,” Reyes says, “it can cost her life.”

Even if a woman lives relatively close to a hospital, that doesn’t mean she will receive respectful, quality care during labor and delivery. For example, expecting mothers often aren’t allowed accompanying family members or friends inside a hospital, so they endure one of the most trying experiences of their lives alone. Only hours later are visitors allowed.

Birth should be a totally unique experience.

Many women coming from rural regions in Chiapas also believe in keeping warm immediately following childbirth to ensure they can breastfeed, so they and their babies avoid cold water and wrap in thick blankets—even on the hottest days. These practices aren’t always respected in urban hospitals.

“We have seen that having a child has turned into a painful experience in all aspects—physically, socially, emotionally, and economically,” Reyes says. “It doesn’t have to be that way. On the contrary, birth should be a totally unique experience.”

Under PIH’s watch, it will be. Patrick Elliott, clinical director for PIH in Mexico, says that quality maternal care is a result of improving supply to better meet the needs and hopes of expectant mothers. Hospitals and maternal waiting homes must be well-stocked and have adequate space with well-trained staff to guarantee a good birth experience. And more expecting mothers will be open to clinic or hospital-based births, he says, when access to transportation, food, housing, or improper medical practices are no longer barriers.

PIH is laying that groundwork at the community level. First-year doctors, called pasantes, identify and closely monitor pregnant women living near the 10 clinics PIH supports throughout rural Chiapas. Community health workers who specialize in maternal health will soon be recruited and trained to coach and connect women with care throughout their pregnancies. And PIH staff are reaching out to local traditional birth attendants to ensure they have improved training and equipment for the births they do attend, while encouraging their improved integration into the health system as part of the care team at PIH-supported clinics and the maternal health center.

Reyes recognizes the delicate balance PIH must strike between supporting midwives, while advocating for facility-based births. “In the end, local midwives have done this their entire lives,” she says. “They have the women’s trust; we can’t be against them. It’s more like we are going to be one big, capable team and work together.”

Reyes (right) carries Roblero's newborn to a nearby PIH vehicle to begin the journey back to the mother and daugther's home in Capitán.

Meanwhile, Reyes and staff are preparing the maternal waiting home and birth center in Revolución Mexicana, which previously stood empty and unused. Should all go according to plan, expecting mothers from remote communities will arrive at the house days in advance of their due dates. Once labor begins, Menchú is on hand to care for women through the labor process, offering massage, music, or simply soothing advice and support. The midwife then escorts the women to the hospital immediately before birth. Should complications arise, specialized staff assist with the delivery.  

A refrigerator and more cooking utensils will soon occupy the kitchen, where a cook will make meals for guests. A boiler is being installed so that women and their children have access to warm water out of respect for their beliefs about breastfeeding. Cots are being brought in for those accompanying an expecting mother. Emergency kits are being assembled for rapid care if complications arise.

More nursing staff will join Menchú in coming months, and a clinical supervisor will be hired to coordinate and mentor staff. Eventually, nurses and midwives will use an electronic medical record system to follow patients’ progress. Mobile tablets will also be loaded with an app covering Mexico’s version of the World Health Organization’s Safe Childbirth Checklist, which clinicians can use as a reminder of proper steps to follow during labor, delivery, and postpartum care of mothers and newborns.

All of these pieces will be in place for the maternal waiting home’s official August opening. Until that time, Reyes hopes patients like Roblero will share their stories.

“Clearly we have to do our part to promote the center, but I think it’s worth more when the women themselves pass along their experiences,” Reyes says. “Especially when just a couple of hours could mean the difference between life and death.”