Access to care during labor and delivery and safety to maternal health

cross-sectional analytical study, carried out in five maternity hospitals, four of which are of habitual and intermediate risk and one of high risk. For data collection, data from the maternal medical record and interviews with the puerperal woman were used. In the data analysis, the Chi-square test (p≤0.05) was performed to search for possible associations between the independent variables - model three delays and dependents [Adverse maternal outcomes], [Knowledge about labor/delivery] and [Service satisfaction].

Results:

statistical significance was observed between the adverse maternal outcome and the delay in looking for a health service (p = 0.005) and the delay in transport to the maternity hospital (p = 0.050), while the outcome knowledge about labor/delivery showed statistical association with delay in looking for a health service (p = 0.048). There was no statistically significant difference between the three delays model and satisfaction with the care.

Conclusion:

the women’s knowledge about labor and delivery and the time of access to obstetric care negatively interferes with the maternal outcome at delivery, which directly impacts maternal health safety.

Descriptors:
Health Services Accessibility; Maternal-Child Health Services; Quality of Health Care; Maternal Health; Parturition; Patient Safety

	N	%
It was informed which hospital to look for in an emergency
Yes	399	84.9
No	71	15.1
Visited the maternity ward before delivery
Yes	100	21.3
No	370	78.7
Where did you come from to the maternity hospital?
UBS^* * UBS = Basic Health Unit;	37	7.8
City hospital	44	9.5
Residence	373	79.4
Other	16	3.3
Type of transport used to come to the maternity hospital
SAMU^† † SAMU = Mobile emergency care service	73	15.5
Simple ambulance	25	5.3
Own car	355	75.5
Other	17	3.7
Total	470	100.0

	N	%
Disease developed in the non-hemorrhagic pre-delivery	10	4.5
Disease developed in the infectious pre-delivery	24	10.9
Disease developed in hypertensive pre-delivery	28	12.7
Disease developed in the pre-delivery clinical condition	02	1.0
Disease developed in the metabolic pre-delivery	02	1.0
3rd and 4th degree perineum laceration	60	27.3
Intrapartum complications ^* * n =83 (56 progression dystocia, 02 eclampsia, 03 placental abruption, 18 fetal distress, 04 others);	83	38.2
Complications fourth period (Greenberg)^† † n = 10 (02 eclampsia, 06 postpartum hemorrhage, 02 uterine massage, 01 removal of retained products)	11	4.5
Total	220	100.0

Variables	Adverse maternal outcome
	Yes		No
	N	%	N	%	p-value
Decision to seek care (1st delay) ^† † n = 375 (95 women were excluded being hospitalized for realization of elective/iterative caesarean section); ^‡ ‡ No record – 16 women
Up to 3 hours	109	48.9	114	51.1	p = 0.005
4 to 8 hours	22	34.9	41	65.1
Above 9 hours	46	63.0	27	37.0
Transport time to the health service (2nd delay) ^† † n = 375 (95 women were excluded being hospitalized for realization of elective/iterative caesarean section);
Up to 30 minutes	146	49.7	148	50.3	p = 0.050
31 min to 1h 30 min	50	61.7	31	38.3	p = 0.050
Waiting time for medical care (3rd delay)^† † n = 375 (95 women were excluded being hospitalized for realization of elective/iterative caesarean section);
Up to 15 minutes	111	48.7	117	51.3	p = 0.362
16 to 30 minutes	36	52.2	33	47.8
31 min to 1 hour	32	41.0	46	59.0

Variables	Knowledge on labor and delivery
	Yes		No
	N	%	N	%	p-value
Decision to seek care (1st delay)^† † n = 375 (95 women who were admitted for elective/iterative cesarean section were excluded); ^‡ ‡ No record – 16 women
Up to 3 hours	134	60.1	89	39.9	p = 0.048
4 to 8 hours	45	71.4	18	28.6
Above 9 hours	37	50.7	36	49.7
Transport time to the health service (2nd delay)†
Up to 30 minutes	178	60.2	117	39.8	p = 0.523
31 min to 1 h 30 min	45	56.3	35	43.8	p = 0.523
Waiting time for medical care (3rd delay)†
Up to 15 minutes	145	63.2	84	36.8	p = 0.143
16 to 30 minutes	35	50.7	34	49.3
31 min to 1 hour	43	55.8	34	44.2

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding author: Juliana Vicente de Oliveira Franchi E-mail: jolliveira@yahoo.com.br https://orcid.org/0000-0001-9441-7736