[The need for paradigm change in maternal care: AMIIMSS model, scopes and challenges].

Abstract

Undoubtedly, great advances have been made in terms of maternal and infant morbidity and mortality. However, in Mexican Social Security System, the quality of maternal care is questionable, as reflected in proportions of cesarean births three times higher than those recommended by WHO, abandonment of exclusive breastfeeding and the fact that up to one in three women is a victim of abuse during delivery. Given this, the IMSS decides to implement the model called Integral Maternal Care AMIIMSS, focused on users experience and based on friendly obstetric care, along different stages of the reproductive process. Four pillars underpin the model, women's empowerment, infrastructure adaptation, training and adaptation of processes and standards. Although there are advances, with 73 pre-labor rooms enabled and 14,103 friendly attentions granted, there are pending tasks and challenges. In terms of empowerment, the birth plan needs to be included as an institutional practice. In terms of infrastructure adequacy, a budget is required to build and adapt friendly spaces. In addition, it is necessary to update the staffing tables and include new categories, for an adequate operation of the program. On training, the adaptation of academic plans for doctors and nurses is pending. In terms of processes and regulations, there is a lack of qualitative evaluation of the impact of the program on people's experience and satisfaction and elimination of obstetric violence.