Abstract
BackgroundGlobal disparities in maternal mortality could be reduced by universal facility delivery. Yet, deficiencies in the quality of care prevent some mothers from seeking facility-based obstetric care. Obstetric care navigators (OCNs) are a new form of lay health workers that combine elements of continuous labor support and care navigation to promote obstetric referrals. Here we report qualitative results from the pilot OCN project implemented in Indigenous villages in the Guatemalan central highlands.MethodsWe conducted semi-structured interviews with 17 mothers who received OCN accompaniment and 13 staff—namely physicians, nurses, and social workers—of the main public hospital in the pilot’s catchment area (Chimaltenango). Interviews queried OCN’s impact on patient and hospital staff experience and understanding of intended OCN roles. Audiorecorded interviews were transcribed, coded, and underwent content analysis.ResultsMaternal fear of surgical intervention, disrespectful and abusive treatment, and linguistic barriers were principal deterrents of care seeking. Physicians and nurses reported cultural barriers, opposition from family, and inadequate hospital resources as challenges to providing care to Indigenous mothers. Patient and hospital staff identified four valuable services offered by OCNs: emotional support, patient advocacy, facilitation of patient-provider communication, and care coordination. While patients and most physicians felt that OCNs had an overwhelmingly positive impact, nurses felt their effort would be better directed toward traditional nursing tasks.ConclusionsMany barriers to maternity care exist for Indigenous mothers in Guatemala. OCNs can improve mothers’ experiences in public hospitals and reduce limitations faced by providers. However, broader buy-in from hospital staff—especially nurses—appears critical to program success. Future research should focus on measuring the impact of obstetric care navigation on key clinical outcomes (cesarean delivery) and mothers’ future care seeking behavior.
Highlights
Global disparities in maternal mortality could be reduced by universal facility delivery
Through qualitative interviews we found that both patients and hospital staff valued the addition of Obstetric care navigator (OCN) to the obstetric care team for Indigenous mothers planning to deliver at home with traditional midwives
The model offers the unique benefit of addressing supply and demand-side barriers to quality care in low-resource public hospitals
Summary
Global disparities in maternal mortality could be reduced by universal facility delivery. Deficiencies in the quality of care prevent some mothers from seeking facility-based obstetric care. Quality of care and patient experience have become key targets of global efforts to reduce maternal mortality [1,2,3]. Negative patient-provider interactions—including physical abuse, non-dignified care, and non-consented care—lead mothers to fear, delay, or refuse in-hospital delivery. Material deficiencies and overcrowding in hospitals prevent providers from delivering quality care. Understanding the vital link between quality of care and maternal mortality, the World Health Organization (WHO) has put forth universal standards of maternity care that address key domains across these three levels [3]
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