Access to care for women during childbirth in university hospitals: characterization and associated factors

MONTESCHIO, Lorenna Viccentine Coutinho; SGOBERO, Jenny Karol Gomes Sato; MARCON, Sonia Silva; MATHIAS, Thais Aidar de Freitas

doi:10.1590/1983-1447.2014.01.39841

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Original Papers • Rev. Gaúcha Enferm. 35 (01) • Mar 2014 • https://doi.org/10.1590/1983-1447.2014.01.39841 copy

Access to care for women during childbirth in university hospitals: characterization and associated factors

Acceso de las parturientas para prestación de servicios en los hospitales universitarios: caracterización y factores asociados

Authorship SCIMAGO INSTITUTIONS RANKINGS

This study aimed to analyze the socioeconomic, demographic, obstetric, neonatal and healthcare factors associated with access to care by women during childbirth. It was a transversal study conducted on puerperal women in two university hospitals in the state of Paraná, Brazil in 2011. Access to childbirth was analyzed according to socioeconomic, demographic, obstetric, neonatal and healthcare variables. The puerperal women were interviewed during hospitalization, in the first 72 hours after birth. The data was analyzed by relative frequencies and calculation of the x², considering a significant association when p≤ 0.05. The overall rate of women referred to university hospitals was 17.7%. A significant associated was found between access to childbirth and: residing in other cities; premature birth; underweight newborns; complications in the current pregnancy and the use of ambulances. It was concluded that the associated factors found in this study suggest that pregnant women with some risk required referral to university hospitals.

Perinatal care; Access to health services; Maternities

Healthcare for childbirth at the 1^st hospital sought
Variables	Yes (n= 255)		No (n= 55)
Variables	N	%	N	%	OR	p-valor
Age (years)
<20	66	78.6	18	21.4	1.4	0.432
20-35	170	83.3	34	16.7
>35	19	86.4	3	13.6	0.8	0.715
Secondary Education Concluded
Yes	93	86.1	15	13.9
No	162	80.2	40	19.8	1.5	0.194
Marital status
Married/living together	223	83.5	44	16.5
Single/divorced	32	74.4	11	25.6	1.7	0.147
Occupation
Paid work	110	83.3	22	16.7
Housewife	145	81.5	33	18.5	1.1	0.669
Race/color
White	123	82.0	27	18.0
Black/mixed race	132	82.5	28	17.5	1.0	0.929
City of residence
Location of hospital	196	96.6	7	3.4
Other	59	55.1	48	44.9	22.8	<0.001
No. of pregnancies
Multigravida	147	83.5	29	16.5
Primigravida	108	80.6	26	19.4	1.2	0.504
Complications during pregnancy*
No	138	87.3	20	12.7
Yes	116	76.8	35	23.2	2.1	0.016
Type of birth
Vaginal	148	81.3	34	18.7
Cesarean	107	83.6	21	16.4	0.9	0.605
Gestational age (weeks)*
37 or more	218	84.5	40	15.5
27 to 36	36	70.6	15	29.4	2.3	0.018
Weight of newborn at birth (g)
Greater or equal to 2500	229	84.5	42	15.5
Less than 2500	26	66.7	13	33.3	2.7	0.006
Transport for childbirth
Others	204	90.3	22	9.7
Ambulance	51	60.7	33	39.3	6.0	<0.001
Did newborn require ICU
No	230	83.3	46	16.7
Yes	25	73.5	9	26.5	1.8	0.158

City of residence
Variables	Same as hospital (n=107)		Other (n=203)		OR	p-valor
Variables	N	%	N	%	OR	p-valor
Age (years)
<20	38	35.5	46	22.7	1.9	0.016
20-35	62	57.9	142	69.9
>35	7	6.6	15	7.4	1.1	0.916
Secondary Education Concluded
Yes	24	22.4	84	41.4
No	83	77.6	119	58.6	2.4	<0.001
Marital status
Married/living together	87	81.3	180	88.7
Single/divorced	20	18.7	23	11.3	1.8	0.074
Occupation
Paid work	40	37.4	92	45.3
Housewife	67	62.6	111	54.7	1.4	0.179
Race/color
White	53	49.5	97	47.8
Black/mixed race	54	50.5	106	52.2	0.9	0.769
City of residence
Location of hospital	59	55.1	196	96.5
Other	48	44.9	7	3.5	22.8	<0.001
No. of pregnancies
Multigravida	47	43.9	87	42.9
Primigravida	60	56.1	116	57.1	1.0	0.857
Complications during pregnancy*
No	51	47.7	107	52.7
Yes	56	52.3	95	46.8	1.2	0.374
Type of birth
Vaginal	63	58.9	119	58.6
Cesarean	44	41.1	84	41.4	1.0	0.965
Gestational age (weeks)*
37 or more	80	74.8	178	87.7
27 to 36	27	25.2	24	12.3	2.5	0.002
Weight of newborn at birth (g)
Greater or equal to 2500	89	83.2	182	89.7
Less than 2500	18	16.8	21	10.3	1.8	0.102
Transport for childbirth
Others	49	45.8	177	87.2
Ambulance	58	54.2	26	12.8	8.1	<0.001
Did newborn require ICU
No	90	84.1	186	91.6
Yes	17	15.9	17	8.4	2.1	0.044

Justifications	N	%
University hospital is a reference point for care	11	20.0
Premature birth	10	18.2
Lack of structure for care during labor	10	18.2
Not in labor	8	14.5
No physician at the first service sought	7	12.7
First service does not cover the SUS	3	5.4
Being primiparous	3	5.4
Not known	3	5.4
Total	55	100

Complication	N	%
Hypertensive disturbances	34	23.3
Urinary disturbances	33	22.6
Pain (lumbar or pelvic)	19	13.0
Bleeding	14	9.6
Placenta previa	13	8.9
Premature labor	12	8.2
Prelabor rupture of membranes	11	7.5
Diabetes	6	4.1
Toxoplasmosis	4	2.8
Total complications*	146	100

Universidade Federal do Rio Grande do Sul. Escola de Enfermagem Rua São Manoel, 963 -Campus da Saúde , 90.620-110 - Porto Alegre - RS - Brasil, Fone: (55 51) 3308-5242 / Fax: (55 51) 3308-5436 - Porto Alegre - RS - Brazil
E-mail: revista@enf.ufrgs.br

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[1] Author's address / Endereço do autor / Dirección del autor Lorenna Viccentine Coutinho Monteschio Rua Pioneiro Francisco Alcalde, 666-A, Jardim Higienópolis 87060-373, Maringá, PR E-mail: helorenn@hotmail.com