Nascer em Belo Horizonte: processo decisório e fatores obstétricos associados à via de nascimento.

Abstract

At present, childbirth model care in Brazil is characterized by high rates of unnecessary interventions, such as cesarean sections performed without clinical indications. In this context, possible causes of the increase in proportion of cesareans have been increasingly discussed. Objective: to analyze the decision-making process of pregnant women through birth and estimate the association between obstetric factors and birthway in Belo Horizonte / Minas Gerais, Brazil. Method:This is a cross-sectional study arried out in seven public maternity hospitals and four maternity hospitals that serves Supplementary Health Network in Belo Horizonte, in a period 2011-2013. The difference between the frequencies was tested using Pearson's Chi-square and the Fisher's exact test. Poisson regression models were constructed to assess the association between obstetric factors and birthway. The statistical program Stata, version 14.0 was used. Results: In public maternity hospitals, the sample of 622 postpartum women consisted predominantly of women aged between twenty and 34 years (70.69%), browns, brunettes or mulattoes (66.16%), with a high school education (56.88%), live with their partner (66.31%) and without paidwork (55.60%). The main intercurrence presented by them during pregnancy was hypertensive syndromes (11.60%). Of the women submitted to cesarean section, 46.03% went into labor and 64.71% of the cases, decision was a medical one. Regarding the supplementary health network, sample of 353 puerperae consisted predominantly of women aged between 20 and 34 years (73.33%), brown, mulatto or mulatto skin color (55.36%), with high school education (51.01%), lived with their partner (88.41%) and with paidwork (73.33%). The main intercurrence presented by them in pregnancy was hypertensive syndromes (8.52%). Of the women submitted to cesarean section, 20.78% didn't go into labor and for 39.24% of the cases, decision was a medical one. It was also verified that obstetric factors were associated to birthway both in the public network and in the supplementary health network of Belo Horizonte. Conclusions: The context presented reinforces that need for female empowerment and autonomy, as well as the work of professionals who provide women with individualized care, humanized and based on scientific evidence, after all aspects such as experiences during childbirth can be decisive in the choice of women birthway of future pregnancies.