Introduction

Objectives:

  • Provide information on how maternity waiting homes (MWHs) can play a role in addressing maternal and neonatal morbidity and mortality

  • Share best practices on planning for MWHs

  • Share best practices for operating MWHs

  • Share strategies for sustainability of MWHs

  • Discuss the roles of Nurses and Midwives in MWHs

How to use the toolkit:

The toolkit is divided into chapters, which are listed across the top of each page. You can read the chapters in order, or go directly to the chapter you are interested in. Each chapter includes a list of references and links to useful tools such as floor plans and supply lists. The chapters and tools can be downloaded as PDFs. The list of references and downloadable PDFs can also be found on the Resources page. The Spanish/English button on the top of the toolkit can be used to change the language of the chapters and resources.

Common Questions about Maternity Waiting Homes:

What is a maternity waiting home?

Maternity waiting homes, also called maternal waiting homes or mother’s shelters in some contexts, are safe places where pregnant mothers can stay before and after childbirth, helping to ensure that mothers and newborns receive the care they need before, during and after childbirth. For the purposes of this toolkit we will use the term “maternity waiting home” or “MWH” for consistency. Maternity waiting homes are usually located near health facilities that can provide skilled care during childbirth. While the term Casa Materna is sometimes used to describe a maternity waiting home, it can also refer to a freestanding birth center. In this toolkit we are focused on maternity waiting homes, not freestanding birth centers. For a more detailed overview of maternity waiting homes see the Maternity Waiting Homes Alliance.

Why maternity waiting homes?

Many maternal and neonatal deaths are caused by delays in reaching health care services, or delays in recognizing complications. By providing women with a safe place to stay while waiting for the onset of labor, and during the immediate postpartum period MWHs can improve the health of women and infants during this critical period. In addition, many successful MWHs provide an opportunity for health education and social support for pregnant women.

How can MWHs decrease mortality and morbidity for women and infants who have difficulty accessing care?

Research on MWHs has demonstrated the following benefits for women and infants:

  • MWHs serve as a safety net to mothers ensuring nearby access to skilled delivery at health facilities (1-3).

  • Early identification and treatment of obstetric complications can decrease the chances of maternal mortality and morbidity.

  • There is evidence that MWHs can also improve newborn outcomes and reduce risk of stillbirth (4).

  • MWHs reduce some financial burdens on mothers such as the cost of transportation to healthcare facilities from a far location, and does not increase overall cost of labor and delivery (5).

  • MWHs provide educational support to expecting and postpartum mothers which allows them to recognize changes in their health and pregnancy complications, as well as knowledge of newborn care and family planning (6-8).

  • MWHs have a positive influence on the attendance of antenatal & postnatal care visits, family planning use, and newborn vaccination outcomes (9).

Have Maternity Waiting Homes or Casas Maternas been used in Latin American and Caribbean countries?

MWHs have been used in many countries, including Mexico, Guatemala, El Salvador and Bolivia. Both Cuba and Nicaragua include MWHs/Casas Maternas as part of their national strategies to improve maternal health. Careful attention to quality of services, financial sustainability and community involvement is important to the utilization and success of the MWH strategy in the region (10-13).

  • *denotes open access

    (1) *Bekele BB, Dadi TL, Tesfaye T. The significant association between maternity waiting homes utilization and perinatal mortality in Africa: Systematic review and meta-analysis. BMC Research Notes. 2019;12(1). https://doi.org/10.1186/s13104-019-4056-z

    (2) Lori JR, Wadsworth AC, Munro ML, Rominski S. Promoting access: The use of maternity waiting homes to achieve safe motherhood. Midwifery. 2013;29(10):1095–1102. Scopus. https://doi.org/10.1016/j.midw.2013.07.020

    (3) *Lori JR, Munro‐Kramer ML, Liu H, McGlasson KL, Zhang X, Lee H, Ngoma T, Kaiser JL, Bwalya M, Musonda G, Sakala I. Increasing facility delivery through maternity waiting homes for women living far from a health facility in rural Zambia: A quasi‐experimental study. BJOG: An International Journal of Obstetrics & Gynaecology. 2021;128(11):1804-12. https://doi.org/10.1111/1471-0528.16755

    (4) *Dadi TL, Bekele BB, Kasaye HK, Nigussie T. Role of maternity waiting homes in the reduction of maternal death and stillbirth in developing countries and its contribution for maternal death reduction in Ethiopia: A systematic review and meta-analysis. BMC Health Services Research. 2018;18(1):1-0. https://doi.org/10.1186/s12913-018-3559-y

    (5) Fontanet CP, Kaiser JL, Fong RM, Ngoma T, Lori JR, Biemba G, Munro-Kramer M, Sakala I, McGlasson KL, Vian T, Hamer DH. Out-Of-Pocket expenditures for delivery for maternity waiting home users and Non-users in rural Zambia. International Journal of Health Policy and Management. 2021. https://www.ijhpm.com/article_4067.html

    (6) Belayihun B, Asnake M, Tilahun Y, Zerihun H, Tasissa A, Tilahun Z, Moges F, Taddelle A, Workneh W. Leveraging maternity waiting homes to increase the uptake of immediate postpartum family planning in primary health care facilities in Ethiopia. Ethiopian Journal of Health Development. 2021;35(1).

    (7) Buser JM, Moyer CA, Boyd CJ, Veliz PT, Zulu D, Ngoma-Hazemba A, Mtenje JT, Jones AD, Lori JR. The Association Between Maternity Waiting Home Use and Maternal–Newborn Knowledge: Latent Class Analysis. Journal of Nursing Measurement. 2021;29(2):334-46. https://doi.org/10.1891/JNM-D-19-00093

    (8) *Gurara MK, Van Geertruyden JP, Gutema BT, Draulans V, Jacquemyn Y. Maternity waiting homes as component of birth preparedness and complication readiness for rural women in hard-to-reach areas in Ethiopia. Reproductive Health. 2021;18(1):1-4. https://doi.org/10.1186/s12978-021-01086-y

    (9) *Buser JM, Munro-Kramer ML, Veliz PT, Zhang X, Lockhart N, Biemba G, Ngoma T, Scott N, Lori JR. How maternity waiting home use influences attendance of antenatal and postnatal care. Plos One. 2021;16(1):e0245893. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245893

    (10) *García Prado A, Cortez R. Maternity waiting homes and institutional birth in Nicaragua: Policy options and strategic implications. The International Journal of Health Planning and Management. 2012;27(2):150-66. https://doi.org/10.1002/hpm.1107

    (11) Gómez Cruz M, Vinent González R, Santana Espinosa MC. Atención integral a gestantes vulnerables en hogar materno provincial de Pinar del Río. Revista de Ciencias Médicas de Pinar del Río. 2020;24(6). http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1561-31942020000600008

    (12) Rojas-Ochoa F. Cuba’s maternity homes, 1962–2017: History, evolution, challenges. MEDICC Review. 2019;21:28-33.

    (13) *Ruiz MJ, van Dijk MG, Berdichevsky K, Munguía A, Burks C, García SG. Barriers to the use of maternity waiting homes in indigenous regions of Guatemala: a study of users' and community members' perceptions. Culture, Health & Sexuality. 2013;15(2):205-18. https://doi.org/10.1080/13691058.2012.751128

Women standing in front of a Casa Materna in Ecuador

MWH in Ecuador (Photo: Megan Eagle)