Access to care for women during childbirth in university hospitals: characterization and associated factors

Abstract

This study aimed to analyze the socioeconomic, demographic, obstetric, neonatal and healthcare factors associated with access to care by women during childbirth. It was a transversal study conducted on puerperal women in two university hospitals in the state of Paraná, Brazil in 2011. Access to childbirth was analyzed according to socioeconomic, demographic, obstetric, neonatal and healthcare variables. The puerperal women were interviewed during hospitalization, in the first 72 hours after birth. The data was analyzed by relative frequencies and calculation of the x2, considering a significant association when p≤ 0.05. The overall rate of women referred to university hospitals was 17.7%. A significant associated was found between access to childbirth and: residing in other cities; premature birth; underweight newborns; complications in the current pregnancy and the use of ambulances. It was concluded that the associated factors found in this study suggest that pregnant women with some risk required referral to university hospitals.

Maternal characteristics and type of prenatal care associated with peregrination before childbirth

“…Moreover, this result differs from other studies, which identified the lack of beds available in the institution 1,17 and high-risk pregnancy 18 as the main causes of antepartum peregrination. It is pointed out that, regardless of the peregrination’s etiological factor, this phenomenon contributes to the excessive delay in childbirth care, which can lead to complications in parturition that often evolve to maternal or fetal death 19,20 .…”

“…The influence of the parturient women’s gestational and obstetric characteristics in the access to the referral maternity for childbirth is also mentioned 18 . The descriptive results of the present study showed that the majority of the parturients who peregrinated were women with inadequate gestational age, in their first pregnancy, with no other children, dissatisfied with pregnancy and who reported abortion attempts during pregnancy.…”

Fatores associados à peregrinação para o parto em São Luís (Maranhão) e Ribeirão Preto (São Paulo), Brasil: uma contribuição da coorte BRISA

“…Uma outra pesquisa, com 310 puérperas, em hospitais universitários do Paraná, afirma que o fato de ser primípara, a falta de estrutura e de recursos nas maternidades para atendimento de gestação de alto risco são motivos para encaminhamento das mulheres para um serviço de referência 30 . Estudo realizado no Sudeste brasileiro também verificou associação da variável paridade com a peregrinação para o parto, apontando para a vulnerabilidade das primíparas quanto à peregrinação 1 .…”

“…Outros estudos realizados previamente evidenciaram que peregrinar em busca de atenção médica é mais frequente entre mulheres pretas e pardas seguidas de mulheres brancas 26,30,38 . Cunha et al 25 , em estudo realizado em São Luís, verificaram que as gestantes que mais peregrinaram eram pardas.…”

“…Há, portanto, necessidade de estudos epidemiológicos de base populacional, visto que as pesquisas existentes são com amostras pequenas que utilizaram a abordagem qualitativa 1 . Aqueles que utilizaram abordagem quantitativa são poucos, e esses têm caráter regional ou local 1,29,30 . Apenas um trabalho internacional explorou os caminhos percorridos pela gestante no momento do parto, identificando quatro padrões de deslocamento.…”