Frequency and associated factors with failure to perform the puerperal consultation in a cohort study

Abstract

Objectives: to identify the frequency and factors associated with the non-realization of puerperal consultations in women resident of a medium-sized municipality in Brazil. Methods: a prospective cohort study based on data collected in two time points, the first 48h and after the 42nd day post-childbirth. In order to analyze data, proportions were compared using the chi-square test, and the adjusted analysis was performed using Poisson regression, according to a predetermined hierarchical model. Significance level was set at 5%. Results: of the 572 women included in the study, 24.8% did not perform puerperal consul-tations. The factors associated with the non-realization of puerperal consultations were: lower income (1 st tercile PR= 2.01; CI95%= 1.21-3.33 – 2 nd tercile PR= 1.94; CI95%=1.17-3.20) and schooling (≤ 8 years PR= 2.00; CI95%= 1.24-3.24), comorbidities during preg-nancy (PR= 1.45; CI95%= 1.01-2.09), realization of antenatal care in the public service (PR= 1.74; CI95%= 1.18-2.58) and non-use of contraceptive methods (PR= 3.10; CI95%=1.86-5.16). Conclusions: puerperal revision does not seem to be valued in the antenatal care, mainly in the public health system. An important inequality was identified in the provision of this service, since women more prone to recurring pregnancy and with lower income and schooling were the ones that least returned to the puerperal consultation.

Adesão à consulta puerperal: facilitadores e barreiras

“…Most of the puerperal women claimed to be married; however, the rate of women in stable unions was lower than the results of studies conducted in different locations in the country 11,13 and in other countries 16,19 , where the rates go from 70 to 100%. In the literature, the partner's support during the puerperium is signaled as relevant in moments of emotional fragility and uncertainty 9 and is associated with higher scores of mother-baby bond 17 , positive feelings in the puerperium 19 and higher rates of family planning 18,20 , although in this study, the association between having a partner and greater adherence to the consultation has not been proven.…”

“…In relation to maternal schooling, there was a greater number of respondents with complete high school; however, 56.3% had a schooling level below incomplete High School, indicating that it was a sample with low education. Schooling was lower than that of other samples of puerperal women who participated in national 11,13,19 and international [15][16]19 studies. As well as the results presented in this study, an association of non-adherence to the puerperal consultation and children with low schooling was verified in a study carried out in the southern region of the country.…”

“…[9][10] The interviewed women were in the age group considered as 'fertile age', as well as puerperal women who participated in other national and international studies. [11][12][13][14][15][16][17][18][19][20] However, the mean age (25 years old) was lower than the one found in studies conducted in the southern region of the country 11 , in the city of São Paulo 20 , in Sweden 14 , United States 16 and Poland. 19 Although they were below the age of other studies, no associations were found between adherence and maternal age.…”

“…As well as the results presented in this study, an association of non-adherence to the puerperal consultation and children with low schooling was verified in a study carried out in the southern region of the country. 11 There was predominance of puerperal women who did not have their own income for performing unpaid domestic activities or being students (52.6%). These results are in accordance with data found in the literature, which showed that 49.4 to 77.7% 12,14,19,21 of the puerperal women devoted their time to household activities and did not have their own income.…”

Avaliação do conhecimento de gestantes atendidas em uma estratégia saúde da família de Belém/PA sobre cuidados durante a gravidez

“…A totalidade de gestantes encontradas na pesquisa relataram a importância de ir às consultas e realizar a vacinação, corroborando as pesquisas atuais que a educação em saúde e o reconhecimento dessas informações (vacinas que não contêm agentes vivos e as imunoglobulinas que atualmente são recomendadas para adultos, são seguras e imunogênicas para as mulheres grávidas) é repassado e adquirido pela população, todavia por diversos fatores, estes que extrapolam a área da educação em saúde, tais como ser mal atendida na unidade de saúde por preconceito pela idade, distância da unidade para o domicílio contribuam para que 10-30% das gestantes não realizem o pré-natal adequadamente [9][10][11][12][13][14][15][16] .…”