¿Referencia y contrarreferencia o multi-rechazo hospitalario? Un abordaje cualitativo.

Introduction. The access to a quality health care during pregnancy and the maternal and perinatal results are not only indicators of the development of the country, but also must be taken into account as a complex process -to which we can refer as process health care pregnancy resolution- that allows to visualize the degree of exercise and respect of sexual and reproductive rights. The objective of this study was to write and analyze at microsocial level the characteristics of the referral system regarding obstetric health care and the institutional mechanism that enable this and identify if this system hides a hospital rejection phenomena and the consequences of this on the maternal and perinatal results. Material and Methods. The process for which a group of 35 women in puerperium agreed for an obstetric resolution in a hospital of second level of care for open population in Mexico City was explored. This investigation had as starting point a qualitative design. Results. 57% of women had to search for more than one site to obtain an obstetric resolution: 25% visited two, 17% three, 15% over three. The women that visited more hospitals attended nine throughout 24 hours. They weren't duly treated in all cases before being sent on their own means to other health care institutions. It was also possible to identify that the complications that some women presented and who participated in this research as well as their babies were caused by the untimely care received and generated by the referral and counter referral they were subject to. Conclusions. This study helped observe that due to the current conditions under which they operate, the referral system represents an obstacle for the timely access of obstetric health care, by covering up a multi-rejection hospital phenomena that, in turn, has a negative impact in the correct resolution of pregnancy and on the health of these women. [ABSTRACT FROM AUTHOR]