Comparison of childbirth care models in public hospitals, Brazil.

Sibylle Emilie Vogt,Kátia Silveira Da Silva,Marcos Augusto Bastos Dias

doi:10.1590/s0034-8910.2014048004633

Abstract

OBJECTIVETo compare collaborative and traditional childbirth care models.METHODSCross-sectional study with 655 primiparous women in four public health system hospitals in Belo Horizonte, MG, Southeastern Brazil, in 2011 (333 women for the collaborative model and 322 for the traditional model, including those with induced or premature labor). Data were collected using interviews and medical records. The Chi-square test was used to compare the outcomes and multivariate logistic regression to determine the association between the model and the interventions used.RESULTSPaid work and schooling showed significant differences in distribution between the models. Oxytocin (50.2% collaborative model and 65.5% traditional model; p < 0.001), amniotomy (54.3% collaborative model and 65.9% traditional model; p = 0.012) and episiotomy (collaborative model 16.1% and traditional model 85.2%; p < 0.001) were less used in the collaborative model with increased application of non-pharmacological pain relief (85.0% collaborative model and 78.9% traditional model; p = 0.042). The association between the collaborative model and the reduction in the use of oxytocin, artificial rupture of membranes and episiotomy remained after adjustment for confounding. The care model was not associated with complications in newborns or mothers neither with the use of spinal or epidural analgesia.CONCLUSIONSThe results suggest that collaborative model may reduce interventions performed in labor care with similar perinatal outcomes.

Highlights

Obstetric care in the collaborative model (CM) of hospital care means integrating doctor and obstetric nurse, as well as other health care professionals, such as the doula, into the team
The results suggest that collaborative model may reduce interventions performed in labor care with similar perinatal outcomes
There is limited literature evaluating interventions in shared care, comparing it with the doctor-centered model as the sole care provider in secondary care, the CM is the predominant form of organization in obstetric care in industrialized countries such as England, Germany, the Scandinavian countries, New Zealand, Canada and Australia.[16]

Summary

Introduction

Obstetric care in the collaborative model (CM) of hospital care means integrating doctor and obstetric nurse, as well as other health care professionals, such as the doula, into the team. There is evidence of the potential of midwife-led care to reduce interventions in the care of women at low risk, as long as the health care professionals are duly qualified and follow protocols and directives.[3,11,17] There is limited literature evaluating interventions in shared care, comparing it with the doctor-centered model as the sole care provider in secondary care, the CM is the predominant form of organization in obstetric care in industrialized countries such as England, Germany, the Scandinavian countries, New Zealand, Canada and Australia.[16]

Methods

Results

Conclusion