Prenatal and perinatal care in Governador Valadares, Minas Gerais state, Brazil

Introduction: Prenatal care and the procedures adopted during childbirth are essential to ensure a healthy pregnancy and delivery and prevent complications, without affecting the health of the mother and newborn. Objective: To analyze the prenatal and perinatal care provided in Governador Valadares, Minas Gerais state, Brazil, and to determine whether there is an association between adequate prenatal care and socioeconomic, demographic, behavioral and reproductive factors. Methods: Cross-sectional study with a pre-existing database. The adequacy of prenatal care was analyzed based on three criteria: 1) onset up to the 16th week and a minimum number of checkups according to gestational age; 2) professional practices during prenatal checkups; 3) counseling given to the pregnant women by healthcare professionals. Multivariate logistic regression was used for data analysis. Results: Participants were 437 postpartum women. Prenatal care was considered adequate for 72.5, 93.1 and 50.1% of the participants based on criteria 1, 2 and 3, respectively. The pregnant women who were most likely to receive inadequate prenatal care in relation to criterion 1 were those with the lowest schooling level (OR = 1.68; p = 0.046), who were single (OR = 2.18; p = 0.002), did not work during their pregnancy (OR = 2.18; p = 0.003) and whose pregnancy was unplanned (OR = 1.76; p = 0.023). With respect to perinatal care, the presence of a birth companion and skin-to-skin contact were adequate, but breastfeeding in the first hour of life was not. Conclusion: There is a need to improve the counseling provided by healthcare professionals and include breastfeeding in the first hour of life. The results could contribute to optimizing maternal and child health services in Governador Valadares.


Introduction
Controlling maternal and perinatal mortality depends on monitoring by health services, especially in prenatal and postpartum care. 1 Prenatal care and procedures adopted during labor are essential in preventing perinatal complications. 2 Prenatal care is defined as a set of preventive and health promotion services aimed at ensuring a healthy pregnancy for both the mother and baby. 3 The Brazilian Ministry of Health (MS in Portuguese) recommends at least six prenatal checkups, one in the first trimester, two in the second and three in the third. 4 The risk of mortality in newborns whose mothers had no prenatal care or only three checkups was four times greater than those whose mothers had six appointments. Additionally, when care is not provided at the appropriate times during pregnancy preterm birth may occur. 5,6 Adequate perinatal care requires that the mother be treated within the health system. In order to improve maternal and child health care, the MS created the socalled Stork Network (Rede Cegonha in Portuguese) 7 to reduce mortality in this population, safeguard the health and quality of life of women during pregnancy, childbirth and postpartum, and to ensure better child development. 7,8 The MS advocates for the humanization of both prenatal care and childbirth based on the following strategies: using evidence-based practices; organizing the healthcare network; classifying the risk of pregnant women and newborns; creating a bond between expectant mothers and maternity services; early identification of possible gestational risks; developing educational initiatives to prevent unnecessary interventions; facilitating access to quality health services from basic outpatient care to specialist hospital treatment; and providing quality humanized perinatal care, including the right to have a birth companion present. 2,4,8 National research highlights shortfalls in prenatal care, including difficult access, late onset of care, insufficient prenatal checkups and noncompletion of recommended procedures, negatively affecting the quality and effectiveness of this care. 2,9,10 In addition to quantitative analysis of the aspects included in prenatal care, it is important to identify the factors associated with poor quality care. 2 Pregnant women treated in public health services who had low schooling levels and household income, were single, smoked, consumed alcohol or used drugs during their pregnancy showed higher percentages of inadequate prenatal care. 11,12 In light of the above, and because this topic is little

Results
Participants were 437 postpartum women. The gestational history and characterization of the population studied based on socioeconomic, demographic and behavioral variables are presented in Table 1.
The variables related to the prenatal period, childbirth and postpartum are described in Table 2 Table 3. The significant variables in Table 3 (Table 4). information was not in their records, precluding them from analysis for the variables "number of prenatal checkups" and "first prenatal checkup". b Ten postpartum participants had no prenatal care and were therefore excluded from analysis for the variables "first prenatal checkup" and "prenatal care location". c Fifteen postpartum participants were considered absent for analysis of these variables, ten for having no prenatal care and five for having only one prenatal checkup, thereby precluding assessment of professional practices. Note: *Postpartum participants without the necessary information or who had no prenatal care were excluded from these analyses, as described in the notes for   According to the second criterion, more than 90% of participants in the present study received adequate prenatal care, indicating that they were properly assessed for blood pressure, weight, fundal height and fetal heartbeat. It is important to underscore that other assessment items and tests were not considered because these data were not collected. It should also be noted that information in the present study was The challenge in ensuring that counseling is in fact understood seems to be a combination of the A limitation of the present study was the recall bias of postpartum participants and missing or incomplete data in their medical or prenatal records. In addition, being a local study with a sample from a single facility precludes generalizing the results.

Conclusion
Prenatal care in Governador Valadares was considered adequate for most participants in terms of when care began, the number of checkups, and assessment of the pregnant women. However, analysis of the counseling provided by healthcare professionals showed that care was inadequate for almost half the study population.
Perinatal care was found to be adequate regarding the presence of a birth companion and skin-to-skin contact, but inadequate for breastfeeding in the first hour of life.
The pregnant women most likely to receive inadequate prenatal care in relation to the number of checkups and the onset of care were those with the lowest schooling level, who were single, did not work during their pregnancy and whose pregnancy was unplanned. There is a therefore a need to improve the care provided in Governador Valadares.
This study could contribute to optimizing the prenatal and perinatal services offered to expectant mothers in the municipality and to early identification of the factors associated with inadequate prenatal care.