The Medicalization of Birth and Cesarean Sections in Oaxaca and Mexico States Open Access

Dominguez, Maria (2015)

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Background:Medicalized birth and cesarean sections are the most common method of childbirth in Mexico in both public and private facilities. The current rates of cesarean sections in public institutions are three to four times higher than the 10-15% recommended by the World Health Organization; they are also higher than the 20% rate suggested by the Official Mexican Standard NOM-007-SSA2-1993.

Objective:To understand how and why medicalized birth and cesarean sections have continued despite the development ofNOM-007-SSA2-1993, andto provide recommendations on how to diminish these practices.

Methods:This study is a secondary analysis of qualitative data collected through a partnership between the National Institute of Public Health (INSP) and the National Institute for Women (INMUJERES) in 2012. Data was collected through 11 semi-structured interviews with health care providers in Maternal and Perinatal Care in three public health institutions in Mexico State and Oaxaca State. Data was analyzed thematically with MAXQDA by coding the textual data for key themes and systematically reviewing and summarizing the coded data.

Results:Medicalized childbirth includes the use of artificial oxytocin, amniotomy, and epidural analgesia, with associated high rates of cesarean sections. Although most of the providers interviewed know the NOM-007-SSA2-1993, they continue to regularly perform procedures that are not recommended by the norm. They do not follow a humanized birth model that involves the pregnant woman as a protagonist and takes her decisions into account, without using unnecessary medical procedures. They also do not allow a companion during labor or childbirth. The SSA institution located in Oaxaca is the only institution where the Humanized Birth Model has been implemented. The main reason why the other institutions do not have this program in place was because the environment lacks an adequate infrastructure and human resources.

Discussion:Intervention strategies to reduce the medicalization of birth and the cesarean section rate in Mexico State and Oaxaca State should seek to improve hospital infrastructure, human resources, norm/guidelines adherence, and social support during labor. Shifting from a medicalized to a humanized birth model, could favor the reduction of these common practices among health care providers.

Table of Contents

Chapter 1: Introduction. 1

Chapter 2: Literature Review. 4

Mode of childbirth in Latin America. 4

Medicalized childbirth. 5

Humanized labor and delivery. 6

Mexican Health System, Health Workforce and Official Mexican Standard (Norma Oficial Mexicana, NOM-007-SSA2-1993). 8

Chapter 3: Methods. 10

Research Design. 10

Setting. 10

Instruments. 11

Data Preparation and Analysis. 11

Ethical considerations. 13

Chapter 4: Results. 14

The Regular Labor and Childbirth Experience in a Public Health Institutions. 14

Medicalized interventions in obstetrics hospitals. 15

Perceptions about cesarean use among healthcare workers. 16

Healthcare providers perceptions related to essential equipment, supplies and personnel. 17

Male involvement during prenatal visits, delivery and post partum care. 20

Healthcare providers' perceptions about norms and guidelines. 23

Humanized Childbirth Model program in Oaxaca State. 24

Chapter 5: Discussion. 26

Recommendations. 26

Compliance with legislation. 26

Improving birth outcomes. 28

Promoting the humanized birth model in order to de-medicalize births. 29

Family Member Company benefits for pregnant women. 29

Natural methods for relieving pain. 31

Modification of Physical Infrastructure. 32

Adequate allocation of human resources. 32

Humanized Childbirth Model program in place at SSA Salina Cruz Institution in Oaxaca. 33

Limitations. 34

References. 35

Appendix 1: Qualitative interview guide for health are providers [Spanish version]. 38

Appendix 2: Qualitative interview guide for health care providers [English Version]. 42

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