Comparison of childbirth care models in public hospitals, Brazil

Vogt, Sibylle Emilie; Silva, Kátia Silveira da; Dias, Marcos Augusto Bastos

doi:10.1590/S0034-8910.2014048004633

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Sumário

Original Articles • Rev. Saúde Pública 48 (2) • Apr 2014 • https://doi.org/10.1590/S0034-8910.2014048004633 copy

Comparison of childbirth care models in public hospitals, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

To compare collaborative and traditional childbirth care models.

METHODS

Cross-sectional study with 655 primiparous women in four public health system hospitals in Belo Horizonte, MG, Southeastern Brazil, in 2011 (333 women for the collaborative model and 322 for the traditional model, including those with induced or premature labor). Data were collected using interviews and medical records. The Chi-square test was used to compare the outcomes and multivariate logistic regression to determine the association between the model and the interventions used.

RESULTS

Paid work and schooling showed significant differences in distribution between the models. Oxytocin (50.2% collaborative model and 65.5% traditional model; p < 0.001), amniotomy (54.3% collaborative model and 65.9% traditional model; p = 0.012) and episiotomy (collaborative model 16.1% and traditional model 85.2%; p < 0.001) were less used in the collaborative model with increased application of non-pharmacological pain relief (85.0% collaborative model and 78.9% traditional model; p = 0.042). The association between the collaborative model and the reduction in the use of oxytocin, artificial rupture of membranes and episiotomy remained after adjustment for confounding. The care model was not associated with complications in newborns or mothers neither with the use of spinal or epidural analgesia.

CONCLUSIONS

The results suggest that collaborative model may reduce interventions performed in labor care with similar perinatal outcomes.

Midwifery; Perinatal Care; Maternal-Child Health Services; Outcome Assessment (Health Care); Unified Health System; Cross-Sectional Studies

Characteristic	p	Collaborative model		Traditional model		Total
Characteristic	p	n^a	%	n^a	%	n^a	%
Age (years) (N = 655)	0.951
< 18		68	20.4	66	20.5	134	20.5
18 to 35		259	77.8	249	77.3	508	77.6
> 35		6	1.8	7	2.2	13	2
Schooling (N = 655)	0.043
Elementary education - incomplete		63	18.9	63	19.6	126	19.2
Elementary education - completed		126	37.8	149	46.3	275	42.0
High school - completed		144	43.2	110	34.2	254	38.8
Marital status (N = 655)	0.143
In stable relationship		229	68.8	204	63.4	433	66.1
Not in stable relationship		104	31.2	118	36.6	222	33.9
In paid work (N = 655)	0.008
Yes		116	34.8	145	45.0	261	39.8
No		217	65.2	177	55.0	394	60.2
Economic class (N = 655)	0.582
A2, B1, B2		34	10.2	27	8.4	61	9.3
C		220	66.1	224	69.6	444	67.8
D, E		79	23.7	71	22.0	150	22.9
Self-reported skin color (N = 655)	0.115
White		56	16.8	49	15.2	105	16.1
Black		52	15.6	72	22.4	124	18.9
Mixed race		206	61.9	178	55.3	384	58.6
Other		19	5.7	23	7.1	42	6.4
Antenatal
Antenatal appointments (N = 647)	0.543
1 to 5		80	24.2	70	22.2	150	23.2
≥ 6		251	75.8	246	77.8	497	76.8
Antenatal care (N = 653)	0.051
Unified Health System		300	90.6	276	85.7	576	88.2
Plan/Private		31	9.4	46	14.3	77	11.8

Characteristic	p	Collaborative model		Traditional model		Total
Characteristic	p	n^a	%	n^a	%	n^a	%
Gestational risk factors
Robson group (N = 655)	0.312
Group 1		173	52.0	180	55.9	353	53.9
Group 2		121	36.3	115	35.7	236	36.0
Group 10		39	11.7	27	8.4	66	10.1
Medical history (N = 655)	0.640
Yes		14	4.2	16	5.0	30	4.6
No		319	95.8	306	95.0	625	95.4
Complications during pregnancy (N = 655)	0.217
Yes		80	24	91	28.3	171	26.1
No		253	76	231	71.7	484	73.9
Smoking (N = 655)	0.660
Yes		29	8.7	25	7.8	54	8.2
No		304	91.3	297	92.2	601	91.8
Alcohol use (N = 655)	0.476
Yes		54	16.2	59	18.3	113	17.3
No		279	83.8	263	81.7	542	82.7
Body mass index (N = 635)	0.762
IMC > 30		21	6.4	18	5.8	39	6.1
IMC ≤ 30		306	93.6	290	94.2	596	93.9

Characteristics of the labor

Amniotic membranes^b (N = 655)	0.190
Broken		112	33.6	93	28.9	205	31.3
Unbroken		221	66.4	229	71.1	450	68.7
Cervical dilation (cm)^b (N = 655)	0.763
0 to 3		158	47.4	149	46.3	307	46.9
4 to 10		175	52.6	173	53.7	348	52.6
Meconium^c (N = 655)	0.612
Yes		58	17.4	61	18.9	119	18.2
No		275	82.5	261	81.1	536	81.8
Non-reassuring fetal status^c (N = 654)	0.095
Yes		51	15.3	35	10.9	86	13.1
No		282	84.7	286	89.1	568	86.9
BMI: body mass index

Intervention in labor	p	Collaborative model		Traditional model		Total
Intervention in labor	p	n^a	%	n^a	%	n^a	%
Oxytocin (N = 655)	< 0.001	167	50.2	211	65.5	378	57.7
Amniotomy^b (N = 450)	0.012	120	54.3	151	65.9	271	60.2
Epidural^c(N = 592)	0.196	125	41.4	105	36.2	230	38.9
Non-pharmacological (N = 655)	0.042	283	85.0	254	78.9	537	82.0
Episiotomy^d	< 0.001	40	16.1	196	85.2	236	49.4

					Interventions
Variable	Oxytocin		Artificial rupture		Analgesia		Episiotomy		Non-pharmacological methods
Variable	OR_aj	IC95%	OR_aj	IC95%	OR_aj	IC95%	OR_aj	IC95%	OR_aj	IC95%
Marital status/Stable relationship									1.65	1.08;2.53
Economic class
C					1
D, E					0.77	0.51;1.17
A, B					0.47	0.24;0.92
Robson Group
Group 1	1		1		1
Group 2	1.73	1.19;2.51	0.24	0.11;0.53	1.28	0.88;1.84
Group10	0.44	0.21;0.90	0.96	0.52;1.80	0.36	0.16;0.80
Waters broken on admission					0.58	0.40;0.86
Non-reassuring fetal status	0.52	0.32;0.83							0.37	0.22;0.63
Complications during pregnancy	0.61	0.38;0.96							0.36	0.24;0.56
Cervical dilation (4 cm to 10 cm)			1.88	1.05;3.36
Meconium			1.75	1.02;2.99
Collaborative model	0.52	0.37;0.72	0.61	0.40;0.91	1.31	0.92;1.87	0.03	0.02;0.05	1.52	1.00;2.31
OR^aj: adjusted odds ratio

Variable	Apgar in 1^st minute 0-6		Resuscitation with VPP		Admitted to neonatal unit
Variable	OR_aj	IC95%	OR_aj	IC95%	OR_aj	IC95%
Weight > 2,500 g	0.45	020;1.06	0.35	0.16;0.77	0.27	0.12;0.62
Gestational age ≤ 36 weeks	0.55	0.19;1.60	1.52	065;3.56	6.78	2.15;21.32
Complications during pregnancy	1.23	0.63;2.40	1.04	0.50;2.16	0.86	0.31;2.35
Collaborative model	0.71	0.42;1.19	0.65	0.38;1.10	0.61	0.32;1.16

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E-mail: revsp@usp.br

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[1] Correspondence
: Sibylle Emilie Vogt Rua Santa Clotilde, 100 Casa F1 39400-129 Montes Claros, MG, Brasil E-mail: sibyllecampos@hotmail.com