Abstract
ABSTRACTOBJECTIVE To analyze the maternal characteristics and type of prenatal care associated with peregrination before childbirth among pregnant women in a northeastern Brazilian state.METHODS Quantitative and transversal study, with descriptive and analytical approaches, part of the Nascer em Sergipe research held between June 2015 and April 2016. A total of 768 puerperal women proportionally distributed across all maternities of the state (n = 11) were evaluated. Data were collected in interviews and from prenatal records. The associations between antepartum peregrination and the exposure variables were described in absolute and relative frequencies, crude and adjusted odds ratios and their respective confidence intervals.RESULTS Antepartum peregrination was reported by 29.4% (n = 226) of the interviewees, most of whom sought care in a single service before the current one (87.6%; n = 198). It should be noted that antepartum peregrination was less frequent among women aged ≥ 20 years old (OR = 0.50; 95%CI 0.34–0.71), with high education level (OR = 0.42; 95%CI 0.31–0.59) and a paid job (adjusted OR = 0.59; 95%CI 0.41–0.82), who had been instructed during prenatal care about the referral maternity for childbirth (adjusted OR = 0.88; 95%CI 0.42–0.92), and who used the private service to receive prenatal (adjusted OR = 0.44; 95%CI 0.18–0.86) or childbirth (adjusted OR = 0.96; 95%CI 0.66–0.98) care. No statistical evidence of associations between gestational characteristics and the occurrence of peregrination was observed.CONCLUSIONS Antepartum peregrination suffers interference from the mother’s socioeconomic characteristics, the type of prenatal care received and the source of funding for childbirth.
Highlights
Antepartum peregrination refers to the pregnant woman’s search of hospitalization for labor in more than one health service, which significantly increases the risks of complications in parturition and even of maternal or fetal death[1,2]
The longer this search, the greater the distance traveled by the pregnant woman in labor and, usually, the lower the probability of adequacy of the services found to her needs, especially in cases of patients who have been previously classified as high clinical or obstetric risk during prenatal care[1]
The bivariate analysis of the maternal sociodemographic characteristics as well as those pertaining to the type of prenatal and childbirth care that were statistically associated with antepartum peregrination showed that pregnant women aged ≥ 20 years old (OR = 0.50; 95% confidence intervals (95%CI) 0.34–0.71), with high education level (OR = 0.42; 95%CI 0.31–0.59), a paid job (OR = 0.61, 95%CI 0.44–0.85), who had been instructed on the referral maternity for childbirth (OR = 0.53, 95%CI 0.39–0.73) and received prenatal (OR = 0.21; 95%CI 0.12–0.36) and childbirth care (OR = 0.80; 95%CI 0.76–0.83) from private healthcare services, were those who least peregrinated before childbirth
Summary
Antepartum peregrination refers to the pregnant woman’s search of hospitalization for labor in more than one health service, which significantly increases the risks of complications in parturition and even of maternal or fetal death[1,2]. The longer this search, the greater the distance traveled by the pregnant woman in labor and, usually, the lower the probability of adequacy of the services found to her needs, especially in cases of patients who have been previously classified as high clinical or obstetric risk during prenatal care[1]. Albuquerque et al.[7] and Souza et al.[8] believe that the scarcity of national publications on antepartum peregrination is one of the main unfavorable factors for minimizing or even solving this problem, being motivated mainly by the difficulty in obtaining quantitative information about its frequency among Brazilian women, since there are no public databases for this purpose in the country
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