Factors associated with the occurrence of upright birth in Brazil

Cross-sectional study with 3,073 parturients who had vaginal delivery in 606 health facilities in Brazil, located in health regions with a regional action plan approved in the RC. Socioeconomic, demographic, and obstetric characteristics of the parturients, organizational and management aspects of maternity hospitals, and work processes in childbirth care were evaluated. The multivariate logistic regression model with a hierarchical approach was adjusted to identify the variables associated with UD (outcome), estimating Odds Ratios (OR) with a significance level of 5%.

Results:

Of the evaluated parturient, 6.7% gave birth in the vertical position. The following were associated with a greater chance of PPV: being black (OR=2.07); having 13 or more years of study (OR=3.20); giving birth in a high-risk hospital (OR=1.58); giving birth in PPP rooms (which assisted with labor, delivery, and puerperium in the same environment) in Obstetric Centers (OR=2.07) or in-hospital Normal Delivery Centers (OR=1.62); being assisted by an obstetrician nurse (OR=1.64) or by a midwife (OR=7.62) when compared to a doctor; receiving massage during labor and delivery (OR=1.89); using a stool (OR=4.16) and among women who did not ask for/not receive analgesia (OR=3.15).

Conclusion:

The UD is an event related to racial aspects and the education of the parturient, being stimulated in health establishments where good practices of childbirth care are implemented, with adequate ambiance, and with multidisciplinary teams comprising midwives and obstetric nurses.

Keywords:
Parturition; Natural birth; Maternal health; Maternal-child health services

Characteristics		UBP, n (%)	Other positions, n (%)
Geographic region
	Midwest	24 (5.4)	449 (94.6)
	Northeast	45 (6.6)	563 (93.4)
	North	23 (3.8)	616 (96.2)
	Southeast	59 (7.7)	726 (92.3)
	South	57 (9.2)	511 (90.8)
Age (years)
	19 or less	58 (7.0)	724 (93.0)
	20 to 29	104 (7.1)	1,499 (92.9)
	30 to 39	44 (6.1)	589(93.9)
	40 or more	2 (1.8)	53 (98.2)
Race/color^* * there are deleted or ignored data.
	White	71 (7.6)	705 (92.4)
	Black	39 (10.9)	341 (89.1)
	Brown	91 (5.4)	1,682 (94.5)
	Yellow/oriental	5 (9.1)	60 (90.9)
	Indigenous	2 (3.9)	30 (96.1)
Education^* * there are deleted or ignored data.
	0 to 5	10 (3.8)	311 (96.2)
	6 to 9	49 (5.7)	811 (94.3)
	10 to 12	128 (7.5)	1,602 (92.5)
	13 or more	20 (11.0)	137 (89.0)
Number of deliveries^* * there are deleted or ignored data.
	Primiparous	104 (7.2)	1,388 (92.8)
	One birth	58 (6.2)	756 (93.8)
	Two births	26 (6.3)	385 (93.7)
	Three births	20 (6.6)	329 (93.4)
Type of management
	Shared	25 (9.3)	199 (90.7)
	State	60 (6.8)	979 (93.2)
	Municipal	123 (6.5)	1,687 (93.5)
Total of deliveries in 2015
	0 to 2,500	67 (5.9)	943 (94.1)
	2,501 to 5,000	83 (5.2)	1,337 (94.8)
	More than 5,000	58 (11.2)	585 (88.8)
High risk hospital^* * there are deleted or ignored data.
	No	136 (5.8)	2,172 (94.2)
	Yes	72 (9.3)	682 (90.7)
Iniciativa Hospital Amigo da Criança
	No	95 (6.1)	1,577 (93.9)
	Yes	113 (7.8)	1,288 (92.2)
PPP rooms in OC
	None	135 (5.6)	2,237 (94.34)
	1 or more	73 (10.4)	628 (89.6)
PPP rooms in IH NDC
	None	170 (6.1)	2,449 (93.9)
	1 or more	38 (9.8)	416 (90.2)
Professional who assisted the delivery^* * there are deleted or ignored data.
	Doctor	113 (5.3)	1,980 (94.7)
	Nurse	83 (8.8)	854 (91.2)
	Midwife	5 (32.6)	8 (67.4)
	No assistance	7 (28.1)	22 (71.9)
Presence of a companion^* * there are deleted or ignored data.
	No	9 (4.2)	2,667 (95.8)
	Yes	199 (6.9)	2,667 (93.1)
Privacy^* * there are deleted or ignored data.
	No	24 (4.5)	422 (95.5)
	Yes	59 (4.7)	1,258 (95.3)
Food offer^* * there are deleted or ignored data.
	No	90 (5.1)	1,462 (94.9)
	Yes	118 (8.5)	1,399 (91.5)
Walking^* * there are deleted or ignored data.
	No	35 (4.3)	726 (95.7)
	Yes	173 (7.6)	2,134 (92.4)
Bath with warm water^* * there are deleted or ignored data.
	No	71 (4.7)	1,524 (95.3)
	Yes	137 (9.0)	1,337 (91.1)
Birth ball^* * there are deleted or ignored data.
	No	104 (5.2)	2,003 (94.8)
	Yes	104 (10.4)	856 (89.6)
Massage^* * there are deleted or ignored data.
	No	98 (4.4)	2,011 (95.6)
	Yes	110 (11.8)	851 (88.2)
Sitting in a cowboy style^* * there are deleted or ignored data.
	No	175 6.2)	2,573 (93.8)
	Yes	33 (11.6)	289 (88.4)
Using a stool^* * there are deleted or ignored data.
	No	125 (4.6)	2,579 (95.4)
	Yes	83 (22.1)	284 (77.9)
Analgesia^* * there are deleted or ignored data.
	Asked for and received	5 (2.9)	192 (97.1)
	Asked for and did not receive	16 (6.2)	182 (93.8)
	Did not ask for and received	13 (4.0)	299 (96.0)
	Did not ask for and did not receive	171 (7.5)	2,135 (92.5)

Characteristics^* * Only the variables that remained in the adjusted model were presented.			Crude analysis		Adjusted analysis
			OR (95%CI)	p-value	OR (95%CI)	p-value
Intermediary block
	Race/color (ref.: white)
		Black	2.13 (1.37–3.31)	0.029	2.07 (1.29–3.30)	0.027
		Brown	1.41 (0.97–2.06)		1.37 (0.93–2.01)
		Yellow/oriental	1.74 (0.65–4.65)		1.79 (0.63–5.06)
		Indigenous	0.69 (0.15–3.10)		0.64 (0.14–2.87)
	Education, in years of study (ref.: 0–5)
		6 to 9	1.52 (0.71–3.25)	0.004	1.34 (0.63–2.86)	0.008
		10 to 12	2.05 (1.01–4.18)		1.79 (0.88–3.64)
		13 or more	3.13 (1.30–7.53)		3.20 (1.36–7.53)
	Number of deliveries in 2015 (ref.: 0–2,500)
		2,501 to 5,000	0.88 (0.59–1.30)	0.004	0.66 (0.43–1.02)	0.429
		5,000 or more	1.99 (1.31–3.04)	0.004	1.22 (0.73–2.02)	0.429
	High risk hospital (ref.: no)
		Yes	1.67 (1.19–2.35)	0.003	1.58 (1.10–2.27)	0.013
	Iniciativa Hospital Amigo da Criança (ref.: no)
		Yes	1.29 (0.93–1.78)	0.120	1.26 (0.91–1.75)	0.176
	PPP rooms in OC (ref.: none)
		1 or more	1.95 (1.38–2.74)	<0.001	2.07 (1.45–2.96)	<0.001
	PPP rooms in in-hospital NDC (ref.: none)
		1 or more	1.65 (1.11–2.47)	0.013	1.62 (1.08–2.43)	0.016
	Who assisted the delivery (ref.: doctor)
		Obstetric nurse	1.72 (1.22–2.41)	<0.001	1.64 (1.15–2.32)	<0.001
		Midwife	8.65 (2.61–8.70)		7.62 (2.26–25.68)
		No assistance	6.99 (2.57–9.04)		8.42 (2.64–26.79)
	Proximal block
	Presence of a companion (ref.: no)
		Yes	0.59 (0.26–1.35)	0.212	-	-
	Food offer (ref.: no)
		Yes	1.72 (1.24–2.39)	<0.001	1.17 (0.81–1.67)	0.354
	Walking (ref.: no)
		Yes	1.84 (1.21–2.80)	0.004	1.04 (0.64–1.70)	0.952
	Bath with warm water (ref.: no)
		Yes	2.01 (1.43–2.81)	<0.001	1.12 (0.75–1.66)	0.570
	Birth ball (ref.: no)
		Yes	2.10 (1.51–2.92)	<0.001	0.95 (0.63–1.41)	0.643
	Massage (ref.: no)
		Yes	2.90 (2.08–4.02)	<0.001	1.91 (1.33–2.76)	<0.001
	Sitting in a cowboy position (ref.: no)
		Yes	1.98 (1.28–3.07)	0.002	1.09 (0.60–1.74)	0.914
	Using a stool (ref.: no)
		Yes	1.98 (1.28–3.07)	<0.001	4.35 (2.94–6.44)	<0.001
	Analgesia (ref.: did not ask for/did not receive)
		Asked for and did not receive	2.18 (0.69–6.82)	0.017	2.14 (0.68–6.73)	0.044
		Did not ask for and received	1.38 (0.42–4.50)		2.03 (0.61–6.72)
		Did not ask for and did not receive	2.68 (0.99–7.25)		3.33 (1.20–9.24)

Associação Brasileira de Saúde Coletiva Av. Dr. Arnaldo, 715 - 2º andar - sl. 3 - Cerqueira César, 01246-904 São Paulo SP Brasil , Tel./FAX: +55 11 3085-5411 - São Paulo - SP - Brazil
E-mail: revbrepi@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] CORRESPONDING AUTHOR: Carlos Martins Neto. Rua Barão de Itapari, 155, Centro, CEP: 79112-200, São Luís (MA), Brasil. E-mail: carlosneto91@hotmail.com