Global Midwifery

Poverty and Quality Care

I wanted to share a photo of the maternity in one of the public hospitals in Honduras. As you can see, the layout is a bit different from any hospital in the United States.



In this hospital, the women labor together in one room. When the head is on the perineum they are moved to the expulsivo (through the door) where the baby will be born. There are some curtains for privacy, but they are not used in this hospital.

Your first thought may be that this is terrible.  That poor quality care is the result to expect in a less wealthy country.  I want to challenge you to look beyond the cultural difference in expectation of privacy in labor, and see some of the wonderful examples of high quality care that were normal.

  • In this hospital, laboring women are not allowed to be admitted into the maternity until they are five centimeters.
  • In this hospital, cervical exams are only performed every four hours to ensure a woman is within the normal bounds on the partogram.
  • In this hospital, if a woman doesn’t respond to an attempted pitocin induction within a pre-specified time frame, she is asked to go home and return tomorrow.
  • In this hospital, contraction pattern is checked by placing a hand on the mother’s belly for 10 full minutes every hour.
  • In this hospital, baby’s heart rate during albor is monitored with a stethoscope to mom’s belly.
  • In this hospital, women are not catheterized to make sure the bladder is empty before pushing.

Yes, some things happen here which are unacceptable in my birth culture.  But there are many things that happen here that are really great examples of a high level of quality care–things I wish would be normal in the United States.

Jennifer Vanderlaan (Author)