"Something that has caught my attention is always to be on the lookout, so that everything goes well ... We have always struggled so that the delivery does not have complications, that it is a clean and safe delivery."

Catarina Pérez  

At the Nebaj District Hospital, Quiché, there is a nurse whose work inspires both the nursing staff and the doctors who work there. She is Catarina Pérez Velasco, known by her classmates as Mrs. Cata.

Seño Cata has been working in the Maternity and labor unit of the Hospital for several years, but it was until recently more than one, that she became head of the area. Almost since taking office, motivated by the search for quality of care, he began coordinating actions with the technical staff of Save the Children, for the improvement of the service provided in the section she directs. These activities include training for effective maternal and natal care, including:

• Clean and safe birth care.
• Infection prevention through hand washing and hygienic precautions.
• Application of oxytocin in the first minute to prevent obstetric hemorrhages.
• Cord clamping in 2 or 3 minutes after birth.
• Traction and contraction of the uterus and expulsion of the placenta.
• Trauma Verification
• Essential care for the newborn.
• Immediate attachment between the baby and the mother.
• AVR (helping babies breathe).
• Gold minute (attention to babies with complications).

Likewise, a monitoring system has been implemented that allows to evaluate the registration of labor events in the childbirth, which is an instrument that serves to collect the intensity, frequency and duration of uterine contractions, cervical dilation, height of the baby's location in the mother's pelvis, as well as the heart rate of the unborn child. The correct monitoring of all stages of childbirth depends on the avoidance of fetal distress and health complications for the mother.

This intervention has been essential for Seño Cata to feel safe in the monitoring and accompaniment process offered to the medical and nursing staff.

“If they don't guide us, they don't reinforce our knowledge, they don't give us more formal training, you say, will I do it? What if they are against me (for demanding compliance with the protocols)? ... But one says: this is something that goes to the benefit of patients, because we have to do it ” (CP).

As a clinical mentor, she has been given the task of verifying that all those involved in childbirth care make a thorough record of what corresponds to them: obstetricians, in terms of dilation, contractions and location of the baby; nursing staff, regarding the mother's vital signs; Pediatric doctors, who observe and attend to the vital signs and general condition of the baby.

“We have to be alert in case something happens that the doctor escapes; some detail We have to remind you of the things that fall within the norm of healthy motherhood ... "" So that the baby does not have complications, we have to be aware, so that the management of the childbirth is correct "(CP).

The information that is collected at the time of delivery enters a database that is subsequently used to extract a sample, which will be part of the process of Measurement of files, through which an analysis of what is established in the childbirth is performed . The study determines if all the steps were noted and if all the actors involved in the process made the corresponding registration. With the results obtained, the factors that cause delays, the actions that need to be optimized, the processes that are important to modify are evaluated and, with these inputs, the improvement strategies are started to be planned.

"Based on that we go with the staff (nursing) and we say: this is not right. Or we say to doctors: we need this ... One has been a little more insistent because that way one avoids Neonatal and mother's complications ” (CP).

The results have resulted in the prioritization of training issues. The workshops that arose accordingly are aimed at reducing the percentage of maternal and neonatal deaths, as well as reducing complications during childbirth.

According to Mrs Cata, since the measurement program began to be used, monitoring has improved. He affirms that the trainings have served so that the nurses are more sensitized about the care they should have with the patients and that they feel strong support in them. She also thinks that the medical staff has a good attitude when she keeps track of the record they make on the birth chart or in the birth book.

For her, since they began using the monitoring tool, they have been able to improve patient care, the risks of fetal suffering, as well as maternal complications have decreased and, when they occur, doctors act more quickly.

According to Paulina Navarro, Technical Supervisor of the Neonatal Health Project of Save The Children, the leadership, permanent care and effectiveness of Mrs. Cata Pérez, have been decisive for the medical and nursing staff to place the necessary importance in the registry and Childbirth monitoring.

"Childbirth I have always taken as a priority, because one has to be 100% delivered ... One has to keep monitoring to see how the labor is going and not trust, because sometimes the human body is changing, we are not all Equals… Not all women are equal… everyone is different and needs different attention ” (CP).