title: Midwifery practice and maternity services: A multisite descriptive study in Latin America and the Caribbean.
abstract: OBJECTIVE
  over the past three decades there has been a social movement in Latin American countries (LAC) to support humanised, physiologic birth. Rates of caesarean section overall in Latin America are approximately 35%, increasing up to 85% in some cases. There are many factors related to poor outcomes with regard to maternal and newborn/infant health in LAC countries. Maternal and perinatal outcome data within and between countries is scarce and inaccurate. The aims of this study were to: i) describe selected obstetric and neonatal outcomes of women who received midwifery care, ii) identify the level of maternal well-being after experiencing midwifery care in 6 Latin America countries.
  
  
  METHODS
  this was a cross sectional and descriptive study, conducted in selected maternity units in Argentina, Brazil, Chile, the Dominican Republic, Peru, and Uruguay. Quantitative methods were used to measure midwifery processes of care and maternal perceptions of well-being in labour and childbirth through a validated survey of maternal well-being and an adapted version of the American College of Nurse-Midwives (ACNM) standardized antepartum and intrapartum data set.
  
  
  METHODS
  Maternity units from 6 Latin American countries.
  
  
  METHODS
  the final sample was a convenience sample, and the total participants for all sites in the six countries was 3009 low risk women.
  
  
  RESULTS
  for the countries reporting, overall, 82% of these low risk women had spontaneous vaginal deliveries. The rate of caesarean section was 16%; the Dominican Republic had the highest rate of Caesarean sections (30%) and Peru had the lowest rate (4%). The use of oxytocin in labour was widely variable, although overall there was a high proportion of women whose labour was augmented or induced. Ambulation was common, with the lowest proportion (48%) of women ambulating in labour in Chile, Uruguay (50%), Peru (65%), Brazil (85%). The presence of continuous support was highest in Uruguay (93%), Chile (75%) and Argentina (55%), and Peru had the lowest (22%). Episiotomies are still prevalent in all countries, the lowest rate was reported in the Dominican Republic (22%), and the highest rates were 52 and 53% (Chile and Peru, respectively). The Optimal Maternal well-being score had a prevalence of 43.5%, adequate score was 30.8%; 25% of the total sample of women rated their well-being during labour and childbirth as poor.
  
  
  CONCLUSIONS
  despite evidence-based guidelines and recommendations, birth is not managed accordingly in most cases. Women feel that care is adequate, although some women report mistreatment.
  
  
  CONCLUSIONS
  More research is needed to understand why such high levels of intervention exist and to test the implementation of evidence-based practices in local settings.
authors.affiliation: Faculty of Medicine, Department of Women's and New Born Health Promotion-School of Midwifery, University of Chile, Santiago, Chile; University Regional Hospital San Vicente de Paul, San Francisco de Macorís, Dominican Republic. Electronic address: lbinfa@med.uchile.cl.
authors.forename: Lorena
authors.initials: L
authors.lastname: Binfa
authors.affiliation: Faculty of Medicine, Department of Women's and New Born Health Promotion-School of Midwifery, University of Chile, Santiago, Chile; University Regional Hospital San Vicente de Paul, San Francisco de Macorís, Dominican Republic. Electronic address: lpantoja@med.uchile.cl.
authors.forename: Loreto
authors.initials: L
authors.lastname: Pantoja
authors.affiliation: Faculty of Medicine, Department of Women's and New Born Health Promotion-School of Midwifery, University of Chile, Santiago, Chile; University Regional Hospital San Vicente de Paul, San Francisco de Macorís, Dominican Republic. Electronic address: jortizc@med.uchile.cl.
authors.forename: Jovita
authors.initials: J
authors.lastname: Ortiz
authors.affiliation: Faculty of Medicine, School of Public Health, Santiago, University of Chile, Chile; University Regional Hospital San Vicente de Paul, San Francisco de Macorís, Dominican Republic. Electronic address: gcavada@med.uchile.cl.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Cavada
authors.affiliation: Nell Hodgson Woodruff School of Nursing and Rollins School of Public Health, Emory University, United States; University Regional Hospital San Vicente de Paul, San Francisco de Macorís, Dominican Republic. Electronic address: Peter.Schindler@emory.edu.
authors.forename: Peter
authors.initials: P
authors.lastname: Schindler
authors.affiliation: Department of Nursing, Universidad Autónoma de Santo Domingo, San Francisco de Macorís, Dominican Republic; University Regional Hospital San Vicente de Paul, San Francisco de Macorís, Dominican Republic. Electronic address: rosaburgos90@yahoo.com.
authors.forename: Rosa Ypania
authors.initials: RY
authors.lastname: Burgos
authors.affiliation: University Regional Hospital San Vicente de Paul, San Francisco de Macorís, Dominican Republic; School of Midwifery, Universidad de Sao Paulo, Brazil. Electronic address: celiamelo@usp.br.
authors.forename: Célia Regina
authors.initials: CR
authors.lastname: Maganha E Melo
authors.affiliation: University Regional Hospital San Vicente de Paul, San Francisco de Macorís, Dominican Republic; School of Midwifery, Universidad de Sao Paulo, Brazil. Electronic address: lucris@usp.br.
authors.forename: Lúcia Cristina Florentino Pereira
authors.initials: LC
authors.lastname: da Silva
authors.affiliation: University Regional Hospital San Vicente de Paul, San Francisco de Macorís, Dominican Republic; School of Midwifery, Universidad de Sao Paulo, Brazil. Electronic address: mop.lima@hotmail.com.
authors.forename: Marlise de Oliveira Pimentel
authors.initials: Mde O
authors.lastname: Lima
authors.affiliation: University Regional Hospital San Vicente de Paul, San Francisco de Macorís, Dominican Republic; School of Midwifery, Universidad de La República, Uruguay. Electronic address: lalavalher@gmail.com.
authors.forename: Laura Valli
authors.initials: LV
authors.lastname: Hernández
authors.affiliation: University Regional Hospital San Vicente de Paul, San Francisco de Macorís, Dominican Republic; School of Midwifery, Universidad de La República, Uruguay. Electronic address: rosslenker@hotmail.com.
authors.forename: Rosana
authors.initials: R
authors.lastname: Schlenker Rm
authors.affiliation: University Regional Hospital San Vicente de Paul, San Francisco de Macorís, Dominican Republic; School of Midwifery, Universidad de La República, Uruguay. Electronic address: vsanchez.uy@gmail.com.
authors.forename: Verdún
authors.initials: V
authors.lastname: Sánchez
authors.affiliation: University Regional Hospital San Vicente de Paul, San Francisco de Macorís, Dominican Republic; Universidad Mayor Nacional de San Marcos, Peru. Electronic address: misolroj2@gmail.com.
authors.forename: Mirian Solis
authors.initials: MS
authors.lastname: Rojas
authors.affiliation: University Regional Hospital San Vicente de Paul, San Francisco de Macorís, Dominican Republic; Hospital Santa Rosa Lima, Peru. Electronic address: bcruzh@hotmail.com.
authors.forename: Betty Cruz
authors.initials: BC
authors.lastname: Huamán
authors.affiliation: University Regional Hospital San Vicente de Paul, San Francisco de Macorís, Dominican Republic; Hospital Santa Rosa Lima, Peru. Electronic address: mltorresch@hotmail.com.
authors.forename: Maria Luisa Torres
authors.initials: ML
authors.lastname: Chauca
authors.affiliation: University Regional Hospital San Vicente de Paul, San Francisco de Macorís, Dominican Republic; School of Midwifery Universidad Católica de La Plata, Argentina. Electronic address: aliciacillo@hotmail.com.
authors.forename: Alicia
authors.initials: A
authors.lastname: Cillo
authors.affiliation: University Regional Hospital San Vicente de Paul, San Francisco de Macorís, Dominican Republic; School of Midwifery Universidad Católica de La Plata, Argentina. Electronic address: sblofeudo03@yahoo.com.ar.
authors.forename: Susana
authors.initials: S
authors.lastname: Lofeudo
authors.affiliation: University Regional Hospital San Vicente de Paul, San Francisco de Macorís, Dominican Republic; School of Midwifery Universidad Católica de La Plata, Argentina. Electronic address: sfz_66@yahoo.com.ar.
authors.forename: Sandra
authors.initials: S
authors.lastname: Zapiola
authors.affiliation: University Regional Hospital San Vicente de Paul, San Francisco de Macorís, Dominican Republic; Johns Hopkins Bloomberg School of Public Health, United States. Electronic address: fweeks2@jhu.edu.
authors.forename: Fiona
authors.initials: F
authors.lastname: Weeks
authors.affiliation: Nell Hodgson Woodruff School of Nursing and Rollins School of Public Health, Emory University, United States; University Regional Hospital San Vicente de Paul, San Francisco de Macorís, Dominican Republic. Electronic address: Jennifer.foster@emory.edu.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Foster
mesh_terms: D000328:Adult; D017691:Caribbean Region; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007843:Latin America; D008427:Maternal Health Services / Q000592:standards*; D008880:Midwifery / Q000379:methods / Q000592:standards*; D009721:Nurse Midwives / Q000592:standards / Q000600:supply & distribution; D036801:Parturition; D018743:Perinatal Care / Q000379:methods / Q000592:standards*; D011247:Pregnancy
keywords: Evidence-based practice; Global health; Latin America; Maternal Health Services; Midwifery; Quality of Health Care