Cluster-randomized Trial Measuring Integration of Professional Midwives and Obstetric Nurses in Rural Clinics in Mexico

Study Overview
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Brief Summary
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Rates and causes of maternal mortality in Mexico have dropped only slightly; thus, reaching the internationally established Millennium Development Milestones (MDM) is still a distant goal. A fundamental part of reducing maternal and infant mortality is ensuring skilled attendance during pregnancy and delivery. This project uses an innovative strategy of integrating professional midwives and licensed obstetric nurses into rural medical centers in the states of Guerrero and Oaxaca, Mexico, to provide prenatal care, delivery services, and puerperium care. The goal of the research is to increase use of best practices in intake, labor, delivery, and puerperium care; decrease the use of unnecessary or harmful care; and improve maternal and neonatal outcomes. We posited that medical centers receiving the intervention would provide better care and have better maternal and neonatal outcomes than those that did not receive the intervention.

Official Title
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Incorporation of Alternative Providers for Care During Pregnancy, Delivery and Postpartum in Rural Public Health Clinics.

Conditions
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Pregnancy

Intervention / Treatment
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* Other: PM/ON integration


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Clinics containing one medical team only (1 doctor and accompanying staff) Clinics less than 2 hours away from a referral hospital Clinics where at least 25 deliveries took place in the previous year Exclusion Criteria: Clinics inaccessible by car Clinics undergoing remodeling

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: PM/ON integration arm<br>Health centers where professional midwives or obstetric nurses are integrated into clinic staff and delivering services. | Other: PM/ON integration<br>* Professional midwives or obstetric nurses are integrated into clinic staff and delivering services.<br>|
| No Intervention: Control<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Use of evidence-based practices during labor, delivery, and postpartum care | Will collect data on deliveries ocurring in sites over 21 month period. | 21 months | 
| volume of prenatal visits, deliveries | We will Assess overall number of first and follow up prenatal visits and deliveries in intervention and control sites | 21 months | 
| Use of harmful or unnecessary practices during labor and delivery | We will assess use of harmful or unnecessary practices during labor and delivery | 21 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Prenatal care, Maternal mortality, Perinatal mortality, Perinatal, Puerperium, Puerperium care, Midwives, Midwife, Obstetric, Nurse, Integration, Alternative personnel, Skilled attendant, Birth attendant, Delivery, Delivery services, Best practices, Rural