Suellen Miller|María José Aguilar Cordero|Aaron Coleman|José F. Figueroa|Sonia Brito-Anderson|R. Dabagh|Venancio García Calderón|Fernández Cáceres|Ariel Romero Fernández|Maxine Nunez
Quality of care in institutionalized deliveries: the paradox of the Dominican Republic
University of California, San Francisco|Universidad Dominicana Organización & Métodos|Universidad Dominicana Organización & Métodos|Profamilia
better understand paradox dominican republic relatively high maternal mortality ratio despite nearly universal institutionalized deliveries trained attendants rapid assessment using adaptation strategic assessment method conducteda multidisciplinary team reviewed national statistics hospital records inventoried facilities observed peripartum clientprovider interactions 14 facilitiesthe major referral hospitals 40 births country occur overcrowded understaffed inexperienced residents overseeing care provided medical students interns nurses uncomplicated labor deliveries overmedicalized complicated ones managed appropriately emergencies dealt timely fashion peripheral hospitals physicians seldom present clients either turned away delivered unprepared nursing staff providers busiest facilities suffered compassion fatigue demoralized overworked facilities quality care lacking delivery birthing process dehumanizedaccess availability institutional delivery alone enough decrease mmr also quality emergency obstetric care saves lives