#1Promoting Safe Births in Rural Mexico & Beyond August 6, 12 p.m. EDT Speakers Valeria Macias Executive Director of Compañeros en Salud Melanie Muñoz Casa Materna Nurse Mariana Montaño Casa Materna Program Coordinator Moderator Leslie Friday Director of Content Partners In Health#2Promoting Safe Births in Rural Mexico https://www.youtube.com/watch?v=0t3ztR5MLAQ#3Content 1. Our context 2. Benefits of group prenatal care . For pregnant women For newborns For health care providers 3. Adaptations to our reality Covid-19 pandemic 4. Expected results 5. Next steps Partners In Health Compañeros En Salud#4Our Context JALTENANGO DE LA PAZ (ÁNGEL ALBINO CORZO) CASA MATERNA CES-SUPPORTED CLINICS MEXICO CITY CHIAPAS *TUXTLA GUTIÉRREZ With headquarters in Ángel Albino Corzo, we currently work in the Casa Materna birth center, a community hospital, and 10 rural public clinics in the Sierra Madre region of Chiapas. We serve people from more than 140 communities in and beyond our catchment area. Partners In Health Compañeros En Salud#5Our Context • Chiapas is one of the poorest and most marginalized states in México Among the highest maternal mortality rate • Low access to health services . · Prenatal consults start in the 2nd trimester • Poor postpartum follow-up ● High rate of homebirths and risk of complications • Distrust of health system • Obstetric violence in hospitals • COVID-19 pandemic Partners In Health Compañeros En Salud#6Goals ● ● ● Reduce maternal and infant morbidity and mortality through increasing care by trained personnel (across the continuum of care) Respectful childbirth: optimizing quality of facility-based childbirth care Address barriers to accessing care in the community Compañeros En Salud Partners In Health Compañeros En Salud#7Sexual and Reproductive health program Primary health care communities Birthing center "Casa Materna" Secondary care - Referrals for high risk pregnancies and emergencies Compañeros En Salud Partners In Health Partners In Health Compañeros En Salud#8Sexual and Reproductive health program Primary health care communities Birthing center "Casa Materna" • Prenatal care → GROUP PRENATAL CARE Postnatal care → GROUP POSTPARTUM CARE Community Health Workers Secondary care - Referrals for high risk pregnancies and emergencies Partners M Compañeros In Health En Salud#9Sexual and Reproductive health program Primary health care communities Birthing center "Casa Materna" Secondary care - Referrals for high risk pregnancies and emergencies Respectful childbirth care • Freedom to walk around ● ● Liquids and soft food during labor Non-pharmacological pain managment Support persons present Choice of delivery position Immediate skin-to-skin contact Delayed cord cutting Active management of 3rd stage of labor Immediate and exclusive breastfeeding Partners Compañeros In Health En Salud#10Journey - 9 (J9) A model of care in which pregnant women are brought together to receive clinical assessment, while sharing information and experiences on issues related to pregnancy and childbirth. • Experience-based learning ● Clinical Evaluation Education . Support ● Women are active participants . There is a moment of socialization Confidentiality agreement The session is facilitated; it is not a class There is a plan for each session that is flexible according to the needs of the group GPC + group postpartum care + psychosocial services + respectful childbirth care Partners In Health Compañeros En Salud#11Cross-Site Training on J9 In February 2020, the Haiti team travelled to Mexico to train us in the J9 program. They shared their experience, results, and materials, and taught us how to facilitate sessions with a group of women. as Partners In Health Compañeros En Salud#12Benefits of Group Prenatal Care - Pregnant Women Increased attendance at prenatal visits and increased prenatal knowledge Patient satisfaction with prenatal care Weight gain greater than minimum Lower risk of postpartum depression Reduced depressive symptoms. Can recruit and retain a demographically vulnerable group Increased use of family planning during postpartum Increased likelihood of vaginal delivery Partners In Health Compañeros En Salud#13Benefits of Group Prenatal Care - Newborns Reduced risk of low birth weight Improved height for gestational age Decreased need for NICU admission and reduced cost Increased likelihood of being vaccinated at 6 and 14 weeks Initiation and continuation of exclusive breastfeeding Partners In Health Compañeros En Salud#14Benefits of Group Prenatal Care - Providers They experienced it as a safe environment in which to provide care and which allowed for meaningful relationships with women. Physicians perceived it as providing better care and a better experience. The model could improve workplace satisfaction, increase provider retention in maternity care, and improve medical care for women. Partners In Health Compañeros En Salud#15Adaptation to Our Reality Number of patients: 8-10 women Frequency ◉ ■ Initial assessment - Offer GPC 1 monthly session, (option for the partner or family member to participate) Option for individual consultation for at-risk patients and/or at need of a referral ◉ Up to 6 months postpartum Time: ◉ 120 minutes for each consult ☐ ■ Extra socialization time Space: ■ ☐ Register with a nurse (basic equipment for clinical examination) Session sharing information and experiences ■ Individual clinical assessment 1 Flow Chart Registro (enfermera-mujeres) 11 1 12 2 1 3 Valoración Clínica (Médico) 10 Educación sanitaria 4 9 5 8 7 6 Partners In Health Compañeros En Salud#16Adaptation to Our Reality - COVID-19 ■ COVID-19 was the leading cause of maternal death in Mexico in 2020 Pregnant women are considered a vulnerable group Delayed implementation Communities decided to limit the number of external visitors Communities banned group activities ■ Stigma and mistrust of vaccination Partners In Health Compañeros En Salud#17Expected Results 30% of patients received 5 or more prenatal visits 50% of patients received at least 1 postpartum consult 11% of patients with a complete lab screening at the first prenatal visit 80% of patients attending the GPC will receive 7 sessions 70% of patients attending the GPC will receive 1 postpartum consult 80% of patients attending the GPC will receive a complete lab screening at the first prenatal visit ✓ >50% of patients will be attending GPC by the end of 2022. ✓ 80% of patients attending the GPC have access to a standardized and high-quality care according to Mexican guidelines. ✓ >90% of patients attending the GPC will be satisfied with the model. ✓ By the end of 2023, the GPC model will be set up in the clinics supported by CES.#18Next Steps ✓ Awaiting response from the representatives of the communities ✓ Needs assessment ✓ Training of health care providers ✓ Adequacy of topics ✓ Adequacy of space ✓ COVID-19 vaccines available to pregnant women Rose lind#19Patient Story https://www.youtube.com/watch?v=LXU3of1Wg-o&ab channel=Compa%C3%B1erosEnSalud https://companerosensalud.mx/blog/olga-y-omar#20Thank You