Background
Methods
Study design
Healthcare models for pregnant and puerperal women
Sample size and data collection
Variables
Statistical analysis
Ethical aspects
Results
Study population and prevalence of deliveries
Variables | Hospital category | p-value | |||
---|---|---|---|---|---|
Public | Private | ||||
N | % | N | % | ||
Maternal age | 1019 | 100.0 | 325 | 100.0 | |
<20 years | 239 | 23.5 | 23 | 7.1 | 0.000 |
≥20 years | 780 | 76.5 | 302 | 92.9 | |
Parity | 1019 | 100.0 | 325 | 100.0 | |
Primiparous | 482 | 47.3 | 189 | 58.2 | 0.001 |
Multiparous | 537 | 52.7 | 136 | 41.8 | |
Maternal educational level | 1019 | 100.0 | 325 | 100.0 | |
≤8 years | 485 | 47.6 | 23 | 7.1 | 0.000 |
>8 years | 534 | 52.4 | 302 | 92.9 | |
Working outside of the home | 1019 | 100.0 | 325 | 100.0 | |
Yes | 227 | 22.3 | 198 | 60.9 | 0.000 |
No | 792 | 77.7 | 127 | 39.1 | |
Maternal skin color | 1019 | 100.0 | 325 | 100.0 | |
White | 155 | 15.2 | 90 | 27.7 | 0.000 |
Black or brown | 864 | 84.8 | 235 | 72.3 | |
Family income | 1019 | 100.0 | 325 | 100.0 | |
<2 minimum monthly salaries | 709 | 69.6 | 26 | 8.0 | 0.000 |
≥2 minimum monthly salaries | 310 | 30.4 | 299 | 92.0 | |
Living with child’s father | 1019 | 100.0 | 325 | 100.0 | |
Yes | 842 | 82.6 | 303 | 93.2 | 0.000 |
No | 177 | 17.4 | 22 | 6.8 | |
Number of prenatal consultations | 1019 | 100.0 | 325 | 100.0 | |
<6 consultations | 342 | 26.2 | 10 | 3.1 | 0.000 |
≥6 consultations | 677 | 73.8 | 315 | 96.9 | |
Prenatal care in private network | 972 | 100.0 | 325 | 100.0 | |
Yes | 86 | 8.8 | 323 | 99.4 | 0.000 |
No | 886 | 91.2 | 2 | 0.6 | |
Prenatal care at the place of childbirth | 972 | 100.0 | 325 | 100.0 | |
Yes | 123 | 12.7 | 50 | 15.4 | 0.221 |
No | 849 | 87.3 | 275 | 84.6 | |
Level of hospital care | 1019 | 100.0 | 325 | 100.0 | |
Low complexity | 927 | 91.0 | 325 | 100.0 | 0.000 |
High complexity | 92 | 9.0 | 0 | 0.0 | |
Day when childbirth occurred | 1019 | 100.0 | 325 | 100.0 | |
Between Wednesday and Friday | 483 | 47.4 | 146 | 44.9 | 0.444 |
Other days | 536 | 52.6 | 179 | 55.1 | |
Volume of deliveries during the shift | 1019 | 100.0 | 325 | 100.0 | |
<8 deliveries/24 hours | 495 | 48.6 | 325 | 100.0 | 0.000 |
≥8 deliveries/24 hours | 524 | 51.4 | 0 | 0.0 | |
Birth weight | 1019 | 100.0 | 325 | 100.0 | |
<2500 grams | 55 | 5.4 | 11 | 3.4 | 0.184 |
≥2500 grams | 964 | 94.6 | 314 | 96.6 | |
Twinning | 1019 | 100.0 | 325 | 100.0 | |
Yes | 14 | 1.4 | 0 | 0.0 | 0.028 |
No | 1005 | 98.6 | 325 | 100.0 | |
Sex | 1019 | 100.0 | 325 | 100.0 | |
Male | 555 | 54.5 | 164 | 50.5 | 0.225 |
Female | 464 | 45.5 | 161 | 49.5 |
Maternal, child and healthcare factors associated with cesarean delivery according to the type of service
Variables | Private | Public | ||||
---|---|---|---|---|---|---|
Cesarean delivery | PR (95 % CI) | Cesarean delivery | PR (95 % CI) | |||
Yes n (%) | No n (%) | Yes n (%) | No n (%) | |||
Maternal age | ||||||
<20 years | 19 (82.6) | 4 (17.4) | 0.95 (0.79 - 1.16) | 52 (21.8) | 187 (78.2) | 0.67 (0.52 - 0.87) |
≥20 years | 261 (86.4) | 41 (13.6) | 253 (32.4) | 527 (67.6) | ||
Parity | ||||||
Primiparous | 163 (86.2) | 26 (13.8) | 1.00 (0.92 - 1.10) | 160 (33.2) | 322 (66.8) | 1.23 (1.02 - 1.48) |
Multiparous | 117 (86.0) | 19 (14.0) | 145 (27.0) | 392 (73.0) | ||
Maternal educational level | ||||||
≤8 years | 19 (82.6) | 4 (17.4) | 0.95 (0.79 - 1.16) | 125 (25.8) | 360 (74.2) | 0.76 (0.63 - 0.93) |
>8 years | 261 (86.4) | 41 (13.6) | 180 (337) | 354 (66.3) | ||
Working outside of the home | ||||||
Yes | 177 (89.4) | 21 (10.6) | 1.10 (1.00-1.21) | 85 (37.4) | 142 (62.6) | 1.35 (1.10 - 1.65) |
No | 103 (81.1) | 24 (18.9) | 220 (27.8) | 572 (72.2) | ||
Maternal skin color | ||||||
White | 79 (87.8) | 11 (12.2) | 1.03 (0.94 - 1.13) | 63 (40.6) | 92 (59.4) | 1.45 (1.17 - 1.81) |
Black or brown | 201 (85.5) | 34 (14.5) | 242 (28.0) | 622 (72.0) | ||
Family income | ||||||
<2 minimum monthly salaries | 20 (76.9) | 6 (23.1) | 0.88 (0.71 - 1.09) | 182 (26.5) | 521 (73.5) | 0.70 (0.58 - 0.85) |
≥2 minimum monthly salaries | 260 (87.0) | 39 (13.0) | 117 (37.7) | 193 (62.3) | ||
Living with the child’s father | ||||||
Yes | 259 (85.5) | 44 (14.5) | 0.90 (0.81 - 1.00) | 261 (31.0) | 581 (69.0) | 1.25 (0.95 -1.64) |
No | 21 (95.5) | 1 (4.5) | 44 (24.9) | 133 (75.1) | ||
Prenatal care | ||||||
<6 consultations | 7 (70.0) | 3 (30.0) | 0.80 (0.54 - 1.22) | 87 (25.4) | 255 (74.6) | 0.79 (0.64 - 0.98) |
≥6 consultations | 273 (86.7) | 42 (13.3) | 218 (32.2) | 459 (67.8) | ||
Prenatal care in the private network | ||||||
Yes | 279 (86.4) | 44 (13.6) | 1.73 (0.43 - 6.91) | 43 (50.0) | 43 (50.0) | 1.77 (1.40 - 2.24) |
No | 1 (50.0) | 1 (50.0) | 250 (28.2) | 636 (71.8) | ||
Prenatal care at the place of childbirth | ||||||
Yes | 41 (82.0) | 9 (18.0) | 0.94 (0.82 - 1.08) | 47 (38.2) | 76 (61.8) | 1.32 (1.03 - 1.69) |
No | 239 (86.9) | 36 (13.1) | 246 (29.0) | 603 (71.0) | ||
Hospital complexity | ||||||
Low | 280 (86.2) | 45 (13.8) | --------- | 259 (27.9) | 668 (72.1) | 0.56 (0.44 - 0.70) |
High | ------ | ------ | 46 (50.0) | 46 (50.0) | ||
Day of delivery | ||||||
Between Wednesday and Friday | 129 (88.4) | 17 (11.6) | 1.05 (0.96 - 1.14) | 153 (31.7) | 330 (68.3) | 1.12 (0.93 - 1.35) |
Other days | 151 (84.4) | 28 (15.6) | 152 (28.4) | 384 (71.6) | ||
Number of deliveries | ||||||
<8 deliveries in 24 hours | 280 (86.2) | 45 (13.8) | --------- | 171 (34.5) | 324 (65.5) | 1.33 (1.12 - 1.63) |
≥8 deliveries in 24 hours | ------ | ------ | 134 (25.6) | 390 (74.4) | ||
Birth weight | ||||||
<2500 grams | 9 (81.8) | 2 (18.2) | 0.95 (0.72 - 1.26) | 17 (30.9) | 38 (69.1) | 1.03 (0.69 - 1.55) |
≥2500 grams | 271 (86.3) | 43 (13.7) | 288 (29.9) | 676 (70.1) | ||
Twinning | ||||||
Yes | ------ | ------ | --------- | 8 (57.1) | 6 (42.9) | 1.93 (1.22 - 3.07) |
No | 280 (86.2) | 45 (13.8) | 297 (29.6) | 708 (70.4) | ||
Sex | ||||||
Male | 140 (85.4) | 24 (14.6) | 0.98 (0.90 - 1.07) | 167 (30.1) | 388 (69.9) | 1.01 (0.84 - 1.22) |
Female | 140 (87.0) | 21 (13.0) | 138 (29.7) | 326 (70.3) |
Variables | Model 1- Distal | Model 2 – Intermediate | Model 3 – Proximal |
---|---|---|---|
RR (95 % CI) | RR (95 % CI) | RR (95 % CI) | |
Lower maternal age (<20 years) | 0.68 (0.51 - 0.91) | 0.65 (0.48 - 0.87) | 0.64 (0.48 - 0.87) |
Primiparous mother | 1.32 (1.06 - 1.64) | 1.35 (1.09 - 1.67) | 1.37 (1.10 - 1.69) |
Lower maternal educational level (<8 years) | 0.93 (0.75 - 1.15) | --------- | --------- |
Mother working outside of the home | 1.25 (1.00 - 1.55) | 1.20 (0.96 -1.51) | 1.21 (0.97 - 1.52) |
White mother | 1.28 (1.00 - 1.63) | --------- | --------- |
Lower family income (<1 minimum monthly salary) | 0.80 (0.65 - 0.99) | 0.84 (0.68 - 1.04) | 0.83 (0.67 - 1.02) |
Mother living with child’s father | 1.19 (0.90 - 1.59) | --------- | --------- |
Prenatal care with less than 6 consultations | --------- | 0.78 (0.62 - 0.98) | 0.78 (0.62 - 0.98) |
Prenatal care in the private network | --------- | 1.48 (1.15 - 1.90) | 1.44 (1.12 - 1.85) |
Prenatal care at the place of childbirth | --------- | 1.26 (0.96 - 1.66) | --------- |
Birth in low-complexity hospital | --------- | 0.60 (0.46 - 0.79) | 0.59 (0.46 - 0.77) |
Birth in hospital with < 8 deliveries/24 h | --------- | 1.25 (1.00 - 1.55) | 1.21 (0.97 - 1.51) |
Twin childbirth | --------- | --------- | 1.77 (1.03 - 3.04) |
Variables | Model 1- Distal | Model 2 – Intermediate | Model 3 – Proximal |
---|---|---|---|
RR (95 % CI) | RR (95 % CI) | RR (95 % CI) | |
Lower maternal age (<20 years) | 0.97 (0.80 - 1.18) | --------- | --------- |
Primiparous mother | 1.00 (0.92 - 1.09) | --------- | --------- |
Lower maternal educational level (<8 years) | 1.01 (0.86 - 1.17) | --------- | --------- |
Mother working outside of the home | 1.10 (0.99 - 1.21) | --------- | --------- |
White mother | 1.02 (0.93 - 1.12) | --------- | --------- |
Lower family income (<1 minimum monthly salary) | 0.91 (0.74 - 1.11) | --------- | --------- |
Mother living with child’s father | 0.89 (0.82 - 0.96) | 0.89 (0.82 - 1.00) | --------- |
Prenatal care with less than 6 consultations | --------- | 0.84 (0.56 - 1.26) | --------- |
Prenatal care in the private network | --------- | 1.41 (0.45 - 4.39) | --------- |
Prenatal care at the place of childbirth | --------- | 0.96 (0.84 - 1.09) | --------- |
Birth in low-complexity hospital | --------- | --------- | --------- |
Birth in hospital with < 8 deliveries/24 h | --------- | --------- | --------- |
Twin childbirth | --------- | --------- | --------- |