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Collaboration with the Costa Rican government C.C.S.S.


    Consultants to the CCSS:

    In recent years, Asociación Mamasol has established close ties with key women’s health care policy makers in the government system, who have enthusiastically worked together with us to create a new vision of care in Costa Rica. Our first project was the complete revision of the C.C.S.S. Maternity Care Protocols, redirecting the focus to more individualized, "woman-centered care," promotion of normal, physiologic birth, and the use of evidence-based obstetric practices. We introduced them to the global Humanization of Childbirth movement, the brilliant "Mother-Friendly Childbirth Initiative" drafted by the Coalition for Improving Maternity Services (CIMS) in the U.S., and up-to-date research on beneficial and harmful obstetric and midwifery practices.

    As a result of Mamasol’s input, the new official government guidelines (published in 2009) recognize women’s human rights in childbirth, and outline all the steps in providing competent, mother-friendly care. Some of the most important changes from the previous guidelines are:

                 ++ Requiring personnel to treat each woman with respect and dignity 

        ++ Requiring the mother’s informed consent for all interventions

        ++ Allowing each woman to have one continuous support person present at all times

        ++ Allowing freedom of movement in labor

        ++ No routine shaving, enemas, pitocin augmentation, artificial rupture of membranes or episiotomies

        ++ Choice in position for birth. No lithotomy (legs up in stirrups)

        ++ Delayed (more than 3 minutes) cord clamping

        ++ Baby to mother's breast Immediately

    Recognizing the abysmal gap between the new guidelines and current health provider practice, we then worked together to design a series of intensive, interactive training sessions with maternity care staff to sensitize them to the issues and motivate them to change their practice. After recently completing the first pilot training series with 20 obstetric nurses from the 4 major hospitals in the capital city of San Jose, we realized that change won’t be easy! However, we are still hopeful and determined, and will continue to be a source of support for both the administrators and direct care providers in the C.C.S.S. health care system.


    To view the complete C.C.S.S. guidelines (in Spanish), click on the link below.