<i>Nascer no Brasil</i>: the presence of a companion favors the use of best practices in delivery care in the South region of Brazil

Monguilhott, Juliana Jacques da Costa; Brüggemann, Odaléa Maria; Freitas, Paulo Fontoura; d'Orsi, Eleonora

doi:10.11606/S1518-8787.2018052006258

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Original Articles • Rev. Saúde Pública 52 • 2018 • https://doi.org/10.11606/S1518-8787.2018052006258 copy

Nascer no Brasil: the presence of a companion favors the use of best practices in delivery care in the South region of Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To analyze if the presence of a companion favors the use of best practices in the delivery care in the South region of Brazil.

METHODS

This is a cross-sectional analysis of the longitudinal study Nascer no Brasil. We analyzed data from 2,070 women from the South region of Brazil who went into labor. The data were collected between February and August 2011, by interviews and medical records. We performed a bivariate and multivariate analysis, calculating the crude and adjusted prevalence ratios using Poisson regression with robust variance estimation. The level of significance adopted was 5%.

RESULTS

Most women had a companion during labor (51.7%), but few remained during delivery (39.4%) or cesarean section (34.8%). Less than half of the women had access to several recommended practices, while non-recommended practices continue to be performed. In the model adjusted for age, education level, source of payment for the delivery, parity, and score of the Brazilian Association of Market Research Institutes, the presence of a companion was statistically associated with a greater supply of liquids and food (aPR = 1.34), dietary prescription (aPR = 1.34), use of non-pharmacological methods for pain relief (aPR = 1.37), amniotomy (aPR = 1.10), epidural or spinal analgesia (aPR = 1.84), adoption of non-lithotomy position in the delivery (aPR = 1.77), stay in the same room during labor, delivery, and postpartum (aPR = 1.62), skin-to-skin contact in the delivery (aPR = 1.81) and cesarean section (PR = 2.43), as well as reduced use of the Kristeller maneuver (aPR = 0.67), trichotomy (aPR = 0.59), and enema (aPR = 0.49).

CONCLUSIONS

In the South region of Brazil, most women do not have access to the best practices in addition to undergoing several unnecessary interventions. The presence of a companion is associated with several beneficial practices and the reduction in some interventions, although other interventions are not impacted.

DESCRIPTORS
Humanizing Delivery; Humanization of Assistance; Patient Rights; Evidence-Based Practice; Maternal-Child Health Services

Variable		n	%	95%CI
Age (n = 2,070)
	12–19 years	461	22.3	20.52-24.11
	20–34 years	1,404	67.8	65.78-69.81
	35 years or more	205	9.9	8.69-11.27
Education level (n = 2,064)
	Incomplete elementary school	634	30.7	28.76-32.74
	Complete elementary school	652	31.6	29.62-33.63
	Complete high school	661	32.0	30.04-34.07
	Complete higher education or more	117	5.7	4.75-6.75
ABIPEME score (n = 2,057)
	A+B	576	28.0	26.10-29.98
	C	1,240	60.3	58.15-62.38
	D+E	241	11.7	10.39-13.18
Parity (n = 2,069)
	Primiparous	890	43.0	40.89-45.16
	Multiparous	1,179	57.0	54.84-59.10
Type of delivery (n = 2,070)
	Vaginal	1,760	85.0	83.42-86.50
	Cesarean	310	15.0	13.50-16.58
Source of payment / delivery (n = 2,070)
	Public	1,857	89.7	88.32-90.95
	Private	213	10.3	9.05-11.67
Presence of companion
	In labor (n = 1,975)	1,021	51.7	49.49-53.90
	In the delivery (n = 1,759)	693	39.4	37.14-41.70
	In the cesarean (n = 310)	108	34.8	29.71-40.34
Labor practices
	Diet offer (n = 1,938)	354	18.2	16.57-20.01
	Dietary prescription (n = 1,374)	463	32.7	30.30-35.19
	Free movement (n = 1.893)	1,124	59.2	57.02-61.44
	NPM pain relief (n = 1,975)	676	32.7	30.67-34.71
	Oxytocin (n = 1,875)	1,008	52.2	49.97-54.42
	Amniotomy (n = 1,858)	954	51.2	48.96-53.50
	Trichotomy (n = 1,875)	843	43.6	41.46-45.88
	Enema (n = 1,875)	714	37.0	34.85-39.15
	Labor analgesia (n = 1,875)	175	9.1	7.86-10.43
Practices in the delivery
	Non-lithotomy position	90	5.1	4.19-6.27
	Episiotomy	912	44.1	41.93-46.21
	Kristeller maneuver	571	27.6	25.76-29.62
	PPP room	289	16.4	14.77-18.25
	Skin-to-skin contact	889	43.3	41.21-45.50

Variable	Presence of companion in labor
	Yes		No		PR	95%CI	aPR^c c Adjusted for age, education level, payment of the delivery (public or private), parity, and ABIPEME score.	95%CI
	n	%	n	%	PR	95%CI		95%CI
Diet offer (n = 1,938)	215	21.1	139	15.1^a a Chi-square test: p < 0.05	1.39	1.15—1.69”	1.34	1.10-1.63^b b Wald test: p < 0.05
Dietary prescription (n = 1,3 74)	2 75	37.5	177	27.7^a a Chi-square test: p < 0.05	1.35	1.16—1.58”	1.34	1.15-1.57^b b Wald test: p < 0.05
Free movement (n = 1.893)	614	62.0	509	56.4^a a Chi-square test: p < 0.05	1.10	1.02-1.19^a a Chi-square test: p < 0.05	1.07	0.99-1.15
NPM pain relief (n = 1,975)	411	40.2	265	2 7.8^a a Chi-square test: p < 0.05	1.45	1.28-1.64	1.37	1.21-1.56^b b Wald test: p < 0.05
Oxytocin (n = 1,875)	524	54.1	461	50.8	1.06	0.98-1.16	1.05	0.96-1.15
Amniotomy (n = 1,858)	517	53.5	435	48.8^a a Chi-square test: p < 0.05	1.09	1.00-1.20”	1.10	1.01-1.21^b b Wald test: p < 0.05
Trichotomy (n = 1,875)	321	33.2	503	55.5^a a Chi-square test: p < 0.05	0.60	0.54-0.66^a a Chi-square test: p < 0.05	0.59	0.53-0.65^b b Wald test: p < 0.05
Enema (n = 1,875)	247	25.5	453	49.9^a a Chi-square test: p < 0.05	0.51	0.45-0.58^a a Chi-square test: p < 0.05	0.49	0.43-0.56^b b Wald test: p < 0.05
Labor analgesia (n = 1,875)	117	12.1	46	5.1^a a Chi-square test: p < 0.05	2.38	1.71-3.31^a a Chi-square test: p < 0.05	1.84	1.33-2.54^b b Wald test: p < 0.05
Vaginal delivery (n = 1,975)	889	87.1	853	89.4	0.97	0.94-1.00	0.99	0.96-1.02

Variable		Presence of companion in the delivery
		Yes		No		PR	95%CI	aPR^c c Adjusted for age, education level, payment of the delivery (public or private), parity, and ABIPEME score.	95%CI
		n	%	n	%	PR	95%CI		95%CI
In the delivery
	Non-lithotomy position (n = 1,753)	49	7.1	41	3.9^a a Chi-square test: p < 0.05	1.83	1.22-2.74”	1.77	1.16-2.72^b b Wald test: p < 0.05
	Episiotomy (n = 1,759)	393	56.7	519	48.7^a a Chi-square test: p < 0.05	1.16	1.06-1.2 7”	1.01	0.93-1.11
	Kristeller maneuver (n = 1,754)	188	27.2	383	36.0^a a Chi-square test: p < 0.05	0.75	0.65-0.87^a a Chi-square test: p < 0.05	0.67	0.58-0.78^b b Wald test: p < 0.05
	PPP room (n = 1,757)	133	19.2	156	14.7”	1.31	1.06-1.62”	1.62	1.31-2.00^b b Wald test: p < 0.05
	Skin-to-skin contact (n = 1,741)	456	66.1	390	3 7.1^a a Chi-square test: p < 0.05	1.78	1.62-1.96”	1.81	1.64-1.99^b b Wald test: p < 0.05
In the cesarean
	Skin-to-skin contact (n = 309)	27	25.0	16	8.0^a a Chi-square test: p < 0.05	3.14	1.77-5.57”	2.43	1.22-4.85^b b Wald test: p < 0.05

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E-mail: revsp@usp.br

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[1] Correspondence: Juliana Jacques da Costa Monguilhott, Rua São Francisco de Sales, 50 Ribeirão da Ilha, 88064-062 Florianópolis, SC, Brasil. E-mail: jujdacosta@gmail.com