From prenatal care to childbirth: a cross-sectional study on the influence of a companion on good obstetric practices in the Brazilian National Health System in Santa Catarina State, 2019

Tomasi, Yaná Tamara; Saraiva, Suélen dos Santos; Boing, Alexandra Crispim; Delziovo, Carmem Regina; Wagner, Kátia Jakovljevic Pudla; Boing, Antonio Fernando

Yaná Tamara Tomasi

Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Saúde Coletiva, Florianópolis, SC, Brazil

http://orcid.org/0000-0001-6034-1497

Suélen dos Santos Saraiva

Instituto Federal de Santa Catarina, Departamento de Saúde e Serviços, Florianópolis, SC, Brazil

http://orcid.org/0000-0002-7059-7055

Alexandra Crispim Boing

Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Saúde Coletiva, Florianópolis, SC, Brazil

http://orcid.org/0000-0001-7792-4824

Carmem Regina Delziovo

Secretaria de Estado da Saúde de Santa Catarina, Superintendência de Planejamento em Saúde, Florianópolis, SC, Brazil

http://orcid.org/0000-0001-8815-7608

Kátia Jakovljevic Pudla Wagner

Universidade Federal de Santa Catarina, Coordenadoria Especial de Biociências e Saúde Única, Curitibanos, SC, Brazil

http://orcid.org/0000-0002-3649-3121

Antonio Fernando Boing

Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Saúde Coletiva, Florianópolis, SC, Brazil

http://orcid.org/0000-0001-9331-1550

Correspondence:
Yaná Tamara Tomasi - Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Saúde Coletiva, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, SC, Brazil. Postcode: 88040-900. E-mail: yanaatomasi@gmail.com

Associate Editor

Maryane Oliveira Campos - 0000-0002-7481-7465

Authors’ contributions:

Tomasi YT, Saraiva SS, Boing AF and Boing AC contributed to the study concept and design, data analysis and interpretation and drafting the first version of the manuscript. Delziovo CR and Wagner KJP contributed to data analysis and interpretation and critically reviewing the manuscript. All the authors have approved the final version of the manuscript and are responsible for all aspects thereof, including the guarantee of its accuracy and integrity.

Variable	n (%)
Age range (years) (n=3,524)
13-19	472 (13.4)
20-35	2,653 (75.3)
36-46	399 (11.3)
Lives with a partner (n=3,559)
Yes	2,864 (80.5)
No	695 (19.5)
Planned pregnancy (n=3,551)
Yes	1,421 (40.0)
No	2,130 (60.0)
Race/skin color (n=3,476)
White	2,205 (63.4)
Black	330 (9.5)
Brown	941 (27.1)
Schooling (years of study) (n=3,476)
≥13	458 (13.0)
10-12	1,853 (52.5)
≤9	1,218 (34.5)
Income per capita (n=3,395)
Wealthiest tertile	1,114 (32.8)
Intermediate tertile	1,147 (33.8)
Poorest tertile	1,134 (33.4)
Number of prenatal care sessions (n=3,428)
1-3	88 (2.6)
4-6	606 (17.7)
7 or more	2,734 (79.7)
Type of delivery (n=3,574)
Vaginal	2,044 (57.2)
Cesarean	1,530 (42.8)
Accompanied during prenatal care sessions (n=3,514)
Yes	2,143 (61.0)
No	1,371 (39.0)
Accompanied during childbirth and postpartum (n=3,573)
Yes	3,254 (91.1)
No	319 (8.9)

Guidance during prenatal care and preparation of birth plan	Total		Presence of companion during prenatal care
	Total		Yes		No
	n	% (95%CI^a)	n	% (95%CI^a)	n	% (95%CI^a)
Pregnant woman received guidance about
Importance of exclusive breastfeeding up to 6 months old	2,181	61.9 (60.3;63.5)	1,361	64.1 (62.0;66.1)	792	58.4 (55.8;61.0)
How to position the baby for breastfeeding	1,636	46.6 (44.9;48.2)	1,021	48.3 (46.2;50.4)	591	43.7 (41.0;46.3)
Importance of physical activity	2,109	60.1 (58.4;61.7)	1,324	62.6 (60.5;64.7)	756	55.9 (53.2;58.5)
Risks of taking medication during pregnancy	2,722	77.2 (75.7;78.5)	1,676	78.9 (77.1;80.6)	1,010	74.3 (71.9;76.6)
Risks of drinking alcohol during pregnancy	2,642	75.0 (73.5;76.4)	1,065	75.7 (73.8;77.5)	1,001	73.7 (71.3;76.0)
Risks of smoking tobacco during pregnancy	2,663	75.6 (74.1;77.0)	1,624	76.6 (74.8;78.4)	1,002	73.7 (71.3;76.0)
Signs of risk during pregnancy for which medical care should be sought	2,831	80.5 (79.1;81.7)	1,731	81.6 (80.0;83.2)	1,066	78.7 (76.5;80.8)
Signs of labor starting	2,255	64.0 (62.4;65.6)	1,408	66.4 (64.4;68.4)	816	60.2 (57.5;62.8)
What can be done during labor to facilitate birth	1,828	52.0 (50.3;53.6)	1,144	54.1 (52.0;56.2)	654	48.2 (45.6;50.9)
Possibility of having a companion at childbirth	2,312	65.5 (63.9;67.0)	1,446	68.0 (66.0;70.0)	832	61.2 (58.6;63.8)
Possibility of visiting the maternity hospital during the prenatal period	1,421	40.3 (38.7;41.9)	899	42.3 (40.3;44.5)	499	36.7 (34.2;39.3)
Received all the recommendations above	616	17.5 (16.3;18.8)	398	18.8 (17.2;20.6)	207	15.2 (13.4;17.2)
Prepared a birth plan with a health professional	261	7.4 (6.6;8.3)	179	8.5 (7.4;9.8)	78	5.8 (4.7;7.2)

Obstetric practices during childbirth	Total		Presence of companion at childbirth
	Total		Yes		No
	n	% (95%CI^a)	n	% (95%CI^a)	n	% (95%CI^a)
Breastfed during the first hour of life	2,394	71.2 (69.7;72.7)	2,206	71.8 (70.2;73.4)	187	64.9 (59.2;70.2)
Was strapped down during childbirth	300	9.2 (8.2;10.2)	248	8.3 (7.4;9.4)	52	18.5 (14.4;23.5)
Episiotomy performed^b	286	14.3 (12.8;15.9)	267	14.3 (12.8;16.0)	19	14.5 (9.4;21.7)
Able to choose position^b	1,017	49.0 (46.8;51.2)	929	50.1 (47.8;52.4)	88	32.3 (24.8;40.9)
Received NPM^c to relieve pain^b	1,066	52.7 (50.5;54.9)	1,033	54.7 (52.5;57.0)	33	24.4 (17.9;32.5)
Shower	984	48.7 (46.5;50.9)	957	50.8 (48.5;53.0)	27	20.0 (14.0;27.7)
Ball	694	34.3 (32.3;36.4)	678	35.9 (33.8;38.1)	16	11.9 (7.4;18.7)
Massage	498	24.6 (22.8;26.6)	484	25.7 (23.8;27.7)	14	10.4 (6.2;16.8)
Analgesic^b	371	18.4 (16.8;20.2)	363	19.3 (17.6;21.2)	8	5.9 (3.0;11.5)

Guidance during prenatal care and preparation of birth plan	Crude PR^a (95%CI^b)	p-value^c	Adjusted^d PR^a (95%CI^b)	p-value^c
Pregnant woman received guidance about
Importance of exclusive breastfeeding up to 6 months old	1.10 (1.04;1.16)	0.001	1.12 (1.05;1.18)	<0.001
How to position the baby for breastfeeding	1.10 (1.03;1.19)	0.009	1.15 (1.06;1.24)	0.001
Importance of physical activity	1.12 (1.06;1.19)	<0.001	1.11 (1.04;1.18)	0.001
Risks of taking medication during pregnancy	1.06 (1.02;1.10)	0.002	1.05 (1.01;1.10)	0.011
Risks of drinking alcohol during pregnancy	1.03 (0.99;1.07)	0.189	1.02 (0.97;1.06)	0.447
Risks of smoking tobacco during pregnancy	1.04 (1.00;1.08)	0.058	1.02 (0.98;1.07)	0.264
Signs of risk during pregnancy for which medical care should be sought	1.04 (1.00;1.07)	0.037	1.03 (0.99;1.06)	0.159
Signs of labor starting	1.10 (1.05;1.16)	<0.001	1.10 (1.04;1.16)	0.001
What can be done during labor to facilitate birth	1.12 (1.05;1.20)	0.001	1.11 (1.04;1.20)	0.003
Possibility of having a companion at childbirth	1.11 (1.06;1.17)	<0.001	1.11 (1.05;1.17)	<0.001
Possibility of visiting the maternity hospital during the prenatal period	1.15 (1.06;1.26)	0.001	1.14 (1.04;1.25)	0.004
Received all the recommendations above	1.24 (1.06;1.44)	0.006	1.27 (1.08;1.50)	0.003
Prepared a birth plan with a health professional	1.47 (1.13;1.89)	0.004	1.51 (1.15;1.97)	0.003

Obstetric practices during childbirth	Crude PR^a (95%CI^b)	p-value	Adjuste^d PR^a (95%CI^b)	p-value^c
Breastfed during the first hour of life	1.11 (1.01;1.21)	0.024	1.11 (1.02;1.22)	0.022
Was strapped down during childbirth	0.45 (0.34;0.49)	<0.001	0.47 (0.35;0.63)	<0.001
Episiotomy performed^e	1.00 (0.93;1.08)	0.947	1.02 (0.94;1.10)	0.631
Able to choose position^e	1.55 (1.20;2.00)	0.001	1.63 (1.24;2.16)	0.001
Received NPM^f to relieve pain^e	2.24 (1.66;3.02)	<0.001	1.96 (1.44;2.65)	<0.001
Shower	2.54 (1.81;3.57)	<0.001	2.22 (1.56;3.13)	<0.001
Ball	3.01 (1.89;4.79)	<0.001	2.63 (1.63;4.25)	<0.001
Massage	2.48 (1.50;4.09)	<0.001	2.05 (1.21;3.46)	0.007
Analgesic^e	3.26 (1.65;6.42)	0.001	2.89 (1.40;5.97)	0.004

[1] Correspondence:
Yaná Tamara Tomasi - Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Saúde Coletiva, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, SC, Brazil. Postcode: 88040-900. E-mail: yanaatomasi@gmail.com

Brasil

Brasil

From prenatal care to childbirth: a cross-sectional study on the influence of a companion on good obstetric practices in the Brazilian National Health System in Santa Catarina State, 2019^* * Study funded by the Santa Catarina State Research Support Foundation: Grant No. 2017 TR1364.

Abstract

Objective

Methods

Results

Conclusion

Brasil

Brasil

From prenatal care to childbirth: a cross-sectional study on the influence of a companion on good obstetric practices in the Brazilian National Health System in Santa Catarina State, 2019* * Study funded by the Santa Catarina State Research Support Foundation: Grant No. 2017 TR1364.

Abstract

Objective

Methods

Results

Conclusion

From prenatal care to childbirth: a cross-sectional study on the influence of a companion on good obstetric practices in the Brazilian National Health System in Santa Catarina State, 2019^* * Study funded by the Santa Catarina State Research Support Foundation: Grant No. 2017 TR1364.