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

## TL;DR

This study examines labor and delivery care in Rio de Janeiro, Brazil, highlighting inequalities based on hospital location and funding, and identifies factors associated with labor and vaginal delivery.

## Contribution

The study provides new insights into disparities in labor and delivery care in a Brazilian state, linking social, geographic, and clinical factors to birthing outcomes.

## Key findings

- 54% of women experienced labor, and 41% had vaginal deliveries.
- Publicly funded hospitals in Rio de Janeiro city were associated with higher rates of labor.
- Vaginal delivery was more common among socially vulnerable women and those with access to good labor practices.

## Abstract

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.

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.

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.

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.

Descrever a atenção ao trabalho de parto (TP) e parto no estado do Rio de Janeiro (ERJ) segundo a localização do hospital e o tipo de financiamento do parto e verificar os fatores sociais, geográficos e assistenciais associados a entrar em trabalho de parto (TP) e a ter parto vaginal (PV).

Estudo seccional de base hospitalar ("Nascer no Brasil II: Pesquisa nacional sobre aborto, parto e nascimento") realizado em 29 hospitais do ERJ. Foram elegíveis puérperas com nascidos vivos e/ou natimortos com idade gestacional ≥ 22 semanas ou peso ≥ 500 g, no total de 1.762 mulheres. As entrevistas foram realizadas nos hospitais, no puerpério imediato, e foram extraídos dados do cartão de pré-natal e do prontuário materno. Foi realizada regressão logística múltipla para os desfechos TP e PV, sendo utilizado um modelo hierarquizado, com estimativa das razões de chance e respectivos intervalos de confiança.

A frequência de TP foi de 54% e de PV 41%. Mostraram associação com entrar em TP ser atendida em hospitais do município do Rio de Janeiro (MRJ), com financiamento público, ser nulípara ou multípara com PV anterior, ter preferência pelo PV no fim da gestação, não ser obesa nem ter apresentado intercorrências na gestação. Ter PV foi associado com menos anos de estudo, ausência de companheiro, ser nulípara ou multípara com PV anterior, ter acesso às boas práticas no TP e parto e ao uso de analgesia no TP, independentemente do tipo de financiamento e da localização do hospital.

Foram verificados avanços na assistência ao parto no ERJ, embora a frequência de TP e de PV ainda seja baixa, bem como a de boas práticas, com melhores resultados para o MRJ. Todas as boas práticas se associaram ao PV, destacadamente o uso de analgesia e a presença de doulas. O PV foi mais frequente em mulheres socialmente vulneráveis.