Assessment of the implementation of the model of integrated and humanised midwifery health services in Santiago, Chile.
OBJECTIVE
during 2007 the Chilean Ministry of Public Health introduced the Model of Integrated and Humanized Health Services, in addition to the Clinical Guide for Humanized Care during Delivery. Three years after its implementation, a study was conducted (i) to describe selected clinical outcomes of women who received care within this model, (ii) to identify the degree of maternal-newborn well-being and (iii) to explore the perception of this humanised attention during labour and delivery by both the professional staff (obstetricians and midwives) and consumers.


METHODS
a cross-sectional, descriptive study using both quantitative and qualitative methods was conducted with 508 women who delivered in two major hospitals within the National Health System in the metropolitan area of Santiago, Chile, from September 2010 until June 2011. The quantitative methods included a validated survey of maternal well-being and an adapted version of the American College of Nurse-Midwives (ACNM) standardised antepartum and intrapartum data set. The qualitative methods included six focus groups discussions (FGDs), with midwives, obstetricians and consumers. Additionally, two in depth interviews were carried out with the directors of the maternity units.


RESULTS
the quantitative findings showed poor implementation of the guidelines: 92.7% of the women had medically induced labours (artificial rupture of the membranes and received oxytocin and epidural anaesthesia), and almost one-third of the women reported discontent with the care they received. The qualitative findings showed that the main complaint perceived by the midwives was that the health system was highly hierarchical and medicalised and that the obstetricians were not engaged in this modality of assistance. The women (consumers) highlighted that professionals (midwives and obstetricians) were highly technically skilled, and they felt confident in their assistance. However, women complained about receiving inadequate personal treatment from these professionals. The obstetricians showed no self-critique, stating that they always expressed concern for their patients and that they provided humanised professional assistance.


CONCLUSIONS
by illuminating the main strengths and weakness with regard to the application of the model, these findings can help to inform strategies and actions to improve its implementation.
Faculty of Medicine, School of Midwifery, Santiago, University of Chile, Avda, Independencia 1027, Santiago-Chile, Chile. Electronic address: lbinfa@med.uchile.cl.
Lorena
L
Binfa
Loreto
L
Pantoja
Jovita
J
Ortiz
Marcela
M
Gurovich
Gabriel
G
Cavada
D001291:Attitude of Health Personnel; D002677:Chile; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D036861:Delivery, Obstetric / Q000379:methods / Q000523:psychology / Q000592:standards; D056348:Emotional Intelligence; D005260:Female; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration; D008880:Midwifery / Q000379:methods / Q000592:standards; D017146:Models, Organizational; D020380:Needs Assessment; D009721:Nurse Midwives / Q000523:psychology / Q000592:standards; D009774:Obstetrics / Q000379:methods / Q000592:standards; D057240:Patient Preference; D018743:Perinatal Care / Q000458:organization & administration; D011247:Pregnancy; D011256:Pregnancy Outcome; D058996:Quality Improvement
Humanisation of labour; Maternal and newborn well-being; Midwifery model