Inequalities in the care for Labor and Delivery in Rio de Janeiro - Birth in Brazil Research II: national survey on abortion, delivery, and birth.

OBJECTIVE

To describe the care for labor and delivery in the state of Rio de Janeiro, Brazil, according to hospital location and type of funding for delivery, and to verify the social, geographic, and care factors associated with going into labor and having a vaginal delivery.

METHODS

This is a cross-sectional hospital-based study ("Birth in Brazil Research II: national survey on abortion, delivery, and birth") conducted in 29 hospitals located in the state of Rio de Janeiro. Women with live births and/or stillbirths with gestational age ≥ 22 weeks or ≥ 500 g weight were eligible, totaling 1,762 women. Interviews were conducted in the hospitals, in the immediate postpartum period. Data were extracted from the prenatal card and maternal medical records. Multiple logistic regression was performed for labor and delivery, using a hierarchical model, with estimated odds ratios and specific confidence intervals.

RESULTS

The frequency of going into labor was 54% and of vaginal delivery, 41.0%. The following aspects were associated with going into labor: provision of care in hospitals located in the municipality of Rio de Janeiro, with public source of funding, being nulliparous or multiparous with previous delivery, preferring vaginal delivery at the end of pregnancy, not being obese and without complications during pregnancy. For vaginal delivery, we observed an association with low level of education, having no partner, being nulliparous or multiparous with previous delivery, having access to good practices as for going into labor and delivery, and use of analgesia during labor, regardless of the type of funding and hospital location.

CONCLUSIONS

We observed advances in labor care in the state of Rio de Janeiro, although the frequency of labor and vaginal delivery is still low, as well as good practices, but with better results for the municipality of Rio de Janeiro. All good practices were associated with vaginal delivery, especially the use of analgesia and the presence of doulas. Vaginal delivery was more frequent in socially vulnerable women.