The Process of Intrapartum Care Among Skilled Birth Attendants in the Dominican Republic and Maternal Perceptions of Care During Labor and Birth: A Case Report

Introduction: The World Health Organization calls for situation analyses of maternity settings globally to improve maternal-newborn health. This study evaluated the care processes of skilled birth attendants and women's satisfaction with the care in a public hospital in the Dominican Republic. The purpose of the assessment was to establish a baseline to build quality improvements.

Methods: A cross-sectional, mixed-methods, observational study was conducted by an international team. Eighty-four participants were included in the Intrapartum Data Set (American College of Nurse-Midwives), and 55 participants completed the Chilean Maternal Well-Being Scale. The data set was analyzed using descriptive statistics. Three focus groups were conducted with health providers, and 4 focus groups were conducted with postpartum women. Themes were derived using content analysis.

Results: Nurses were the skilled birth attendants (SBAs) for 54% of women; 46% were attended by either obstetricians or family medicine residents. Ninety-one percent of newborns with nurse attendants had immediate skin-to-skin contact, compared to 79% of newborns with physician attendants. Newborns breastfed within the first hour of life for 67% of the dyads with nurse SBAs, whereas 24% of newborns attended by physicians did so. The well-being survey indicated most women perceived care was adequate or better, irrespective of attending provider. Nevertheless, 67% of rural women perceived care negatively. Qualitative findings indicated that some women felt neither respected nor heard.

Discussion: When nurses managed the labor and birth, their care was comparable to that of physicians. Moreover, women were more likely to receive evidence-based newborn care, including skin-to-skin contact, immediate breastfeeding, and discharge instructions. Qualitative findings highlighted the discrepancy between health care providers' perception of the care they provided and patients' perceptions of that care. Reflexive practice and frequent communication with patients about their experience of care should be a part of every practitioner's toolkit, wherever that care is provided.