Midwifery
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Randomized Controlled Trial Multicenter Study
Are all skilled birth attendants created equal? A cluster randomised controlled study of non-physician based obstetric care in primary health care clinics in Mexico.
the great majority of births in Mexico are attended by physicians. Non-physician health professionals have never been evaluated or compared to the medical model of obstetric care. This study evaluates the relative strengths of adding an obstetric nurse or professional midwife to the physician based team in rural clinics. ⋯ Mexican National Institute for Women, Mexican National Center for Gender Equity and Reproductive Health, MacArthur Foundation, Bill and Melinda Gates Foundation.
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the professional midwife is a key person for promoting maternal and family health. Not all countries have yet reached the professional standard for midwives set by the International Confederation of Midwives (ICM) and Nepal is one of these countries. This study explores the feasibility to establish a professional midwifery cadre in Nepal that meets the global standards of competencies, and to define a strategy to reach this. ⋯ the study has delivered a proposed strategy for the Government of Nepal for effective management of the midwifery workforce in order to enhance midwives' contribution in maternity care and thus promoting improved maternal and new-born health. The developed analytical framework could be used as an assessment tool also in other countries to establish professional midwifery cadres that meets the global standards of competencies.
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Despite being ranked number one globally in terms of health care cost per capita, the United States (US) has ranked as low as 37th in the world in terms of health care system performance. This poor performance for one of the most developed nations in the world has been reflected in the underachieved attempts of the multiple US health care systems at improving maternal and newborn health, according to the goals set in 2000 by the United Nations with Millennium Development Goals (MDG's) 5: Improve Maternal Health, and 4: Reduce Child Mortality. ⋯ Using data collected from national, state, and city health agencies, trends concerning pregnancy care will be presented and compared to the target goals of MDG-5 and MDG-4, as well as Healthy People 2020, a US government-based initiative to improve health care of all Americans. Findings will demonstrate that urban areas such as Philadelphia are on a path of not reaching goals that have been set by the United Nations and the US government, and by some indicators are moving away in a negative direction from these goals.
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over the last decade Afghanistan has made large investments in scaling up the number of midwives to address access to skilled care and the high burden of maternal and newborn mortality. ⋯ the depth of midwives' contribution in Afghanistan - from increased maternal health care service utilisation to changing community's perceptions of women's education and professional independence - is overwhelmingly positive. Lessons learned can serve as a model to other low resource, post-conflict settings that are striving to increase the workforce of skilled providers.