Cuban maternity homes: a model to address at-risk pregnancy.

12 Feature Like a tropical lullaby, the rocking chairs lay down a languid rhythm accompanied by laughter, bits of gossip, and gripes about the heat. Olga Lydia, 39, anemic, and preparing to give birth to her fi rst child, wonders aloud what it will be like to have a son, when in her heart of hearts she wanted a daughter. Meanwhile, Loreta, 18, and expecting twins, rocks quietly alongside, a smile on her fl aw-less face. Olga Lydia and Loreta are two of the more than 67,000 at-risk expectant mothers[1] served by Cu-ba's network of over 300 maternity homes, receiving comprehensive care and childbirth education in either live-in or ambulatory modalities. Since the fi rst 15 such homes were founded in 1962 in the eastern part of the country, the system has evolved into a national program employing a uniform practice for women presenting certain risk factors during pregnancy. The strategy has helped the country achieve a nearly 100% in-hospital birth rate[2] and lower infant and maternal mortality rates, and partly explains why Save the Children ranks Cuba as the number one developing country in which to be a mother.[3] Prior to 1959, fewer than 20% of all births in Cuba were in hospitals .[4] Most of these institutions, like all health services, were concentrated in cities. Lack of roads in mountainous areas made childbirth especially treacherous there. Thus, women in remote regions faced the worst prognosis, where they often made " long trek[s] to the hospital…incurred labor and delivery complications en route and died. " [5] In the initial stages of the maternity home program in the 1960s, the single criterion for referral was geographic , with expectant mothers from remote rural areas living in maternity homes located near hospitals for all or part of their pregnancy. Rather than embed these facilities in traditional health care settings , existing houses were re-purposed and reconditioned to create a familiar, home-like environment where the health and wellbeing of mother and fetus could be monitored. By providing basic medical services, physical and recreational activities, and health promotion and education in a comfortable setting, the aim was for " expectant mothers to reach their delivery date in optimal health, " says Dr Myrna Ortega of the National Obstetrics and Gynecology Group, former coordinator of the maternity homes program, and now advisor to the Ministry of Public Health's Maternal-Child Department. The strategy worked. These …