Factors associated with obstetric interventions in public maternity hospitals

Keli Regiane Tomeleri Da Fonseca Pinto,Adriana Valongo Zani,Cristina Maria Garcia De Lima Parada,Renne Rodrigues,Mariana Angela Rossaneis,Cátia Campaner Ferrari Bernardy

doi:10.1590/1806-93042020000400009

Abstract

Abstract Objectives: to identify the prevalence and factors associated with obstetric interventions in parturients assisted in public maternity hospitals. Methods: a cross-sectional study with 344 puerperal women, from two public maternity hospitals, referring to childbirth by Sistema Único de Saúde (SUS) (Public Health Service System) in Londrina City, Paraná, Brazil, between January and June 2017. The medical records were the data source. The following obstetric interventions were considered: oxytocin use, artificial rupture of the membranes, instrumental childbirth and episiotomy. Multivariate Poisson regression was used to analyze associated factors, with p<5% being significant. Results: the prevalence of obstetric intervention was 55.5%, the maximum number of interventions in the same parturient woman was three. The most frequent interventions were the use of oxytocin (50.0%) and artificial rupture of membranes (29.7%). The variables associated on maternal disease (p=0.005) and intrapartum meconium (p=0.022) independently increased, the risk of obstetric intervention, while dilation was equal to or greater than 5 cm at admission, there was a protective factor against this outcome (p=0.030). Conclusion: the prevalence of obstetric interventions was high. In the case of maternal disease and intrapartum meconium, special attention should be given to the parturient woman, in order to avoid unnecessary interventions. Thus, the maternity hospitals need to review their protocols, seeking good practices in childbirth care.

Highlights

Childbirth and birth care have been marked worldwide by the adoption of interventionist practices with the use of medications, technological devices and other procedures to accelerate or control the parturition process
Considering the importance of health services evaluating the developed obstetric care, this study aims to identify the prevalence and factors associated with obstetric interventions in parturients assisted in public maternity hospitals
This study identified a high prevalence of obstetric interventions, especially in the use of oxytocin and the artificial rupture of membranes in women assisted in the public maternity hospitals

Summary

Introduction

Childbirth and birth care have been marked worldwide by the adoption of interventionist practices with the use of medications, technological devices and other procedures to accelerate or control the parturition process. In the context of good birth-related practices, it is expected that any intervention to the natural and spontaneous process of labor and childbirth should have plausible justification for such,[2] because, the use of health technology contributes in reducing maternal and neonatal morbidity and mortality, its excessive and/or unnecessary use leads women and their newborns to health risks.[3]. In this context, recommendations for childbirth care have been based on humanized care, aiming to promote healthy deliveries and births, with the guarantee of women’s protagonism and respecting their privacy and autonomy.[4] these recommendations have proved insufficient, because, in some services, the scenario remains unchanged, with the use of unnecessary interventions and without scientific evidence. A study conducted in the South of Brazil identified several procedures harmful to labor and some were used inappropriately, such as fasting prescription, oxytocin use, amniotomy, episiotomy and delivery in the lithotomic position.[2]

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Conclusion