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Childbirth Care for Adolescents and Advanced Maternal Age In DOI: 10.1590/1413-81232021263.12492020 847 AR Childbirth care for adolescents and advanced maternal age TI C in maternities linked to Rede Cegonha LE Elaine Fernandes Viellas (https://orcid.org/0000-0001-5259-8102) 1 Thereza de Lamare Franco Netto (https://orcid.org/0000-0001-6186-8311) 2 Silvana Granado Nogueira da Gama (https://orcid.org/0000-0002-9200-0387) 1 Márcia Leonardi Baldisserotto (https://orcid.org/0000-0001-6907-2510) 1 Priscila Fernandes do Prado Neto (https://orcid.org/0000-0001-9809-7186) 3 Mariana Ramos Rodrigues (https://orcid.org/0000-0001-8493-1379) 4 Katrini Guidolini Martinelli (https://orcid.org/0000-0003-0894-3241) 5 Rosa Maria Soares Madeira Domingues (https://orcid.org/0000-0001-5722-8127) 6 Abstract Based on the Rede Cegonha guidelines that propose the strengthening of women’s sexu- al and reproductive rights, we sought to present a brief overview of issues related to reproductive planning and to analyze obstetric practices in childbirth care for adolescents and women of ad- vanced age in maternity hospitals linked to Rede Cegonha. Data were extracted from an assess- ment conducted in 2017, based on information from the interview with puerperal women and 1 Escola Nacional de from the hospital record. For age extremes, the Saúde Pública, Fiocruz. R. high proportion of unplanned pregnancies and Leopoldo Bulhões 1480, Manguinhos. 21041-210 low use of contraception means problems in ac- Rio de Janeiro RJ Brasil. cessing family planning programs. Adolescents [email protected] are more exposed to the presence of a companion 2 Secretaria de Estado da Justiça e Cidadania do and less to the use of analgesia in labor. Advanced Distrito Federal, Governo maternal age were more likely to use analgesia in do Distrito Federal. Brasília labor and to give birth in the lithotomy position, DF Brasil. 3 Desenvolvimento de being less exposed to amniotomy. Although Rede Políticas Sociais, Ministério Cegonha is an excellent strategy for improving da Saúde. Brasília DF assistance to childbirth, attention is still needed to Brasil. 4 Secretaria de Estado da the use of potentially unnecessary or not recom- Saúde do Distrito Federal, mended interventions, with greater incentive to Governo do Distrito good obstetric practices. Federal. Brasília DF Brasil. 5 Programa de Pós- Key words Maternal age, Pregnancy, Maternal Graduação em Saúde and child health services, Labor, Childbirth Coletiva, Universidade Federal do Espírito Santo. Vitória ES Brasil. 6 Instituto Nacional de Infectologia Evandro Chagas, Fiocruz. Rio de Janeiro RJ Brasil. 848 et al. Viellas EF Viellas Introduction Ministry of Health instituted, in 2011, Rede Ceg- onha (RC), seeking to assure all women, whether The Brazilian National Guidelines for Compre- adolescents or old age, the right to reproductive hensive Health Care for Adolescents and Youth planning and humanized care pregnancy, child- (Diretrizes Nacionais para Atenção Integral à birth and the puerperium, as well as children the Saúde de Adolescentes e Jovens)1 follow the defi- right to safe birth and healthy growth and devel- nition of the adolescent age group established by opment9. To this end, the RC strategy has prior- the World Health Organization (WHO)2, which itized actions related to adopting good practic- delimits it to the second decade of life, i.e., from es in assisting parturient women in maternity 10 to 19 years old. These Guidelines bring the legal wards, practices recommended by WHO10. instruments to protect adolescents’ fundamental It is in this context of strengthening women’s right to health. Universal and equal access to ac- sexual and reproductive rights that the present tions and services for the promotion, protection study sought to present a brief overview of issues and recovery of this population’s health is guar- related to reproductive planning and to analyze anteed, for instance, by the Statute of Children obstetric practices in childbirth care for adoles- and Adolescents (ECA - Estatuto da Criança e do cents and elderly women in maternities linked to Adolescente)3, which seeks to ensure, even, pre and RC, to subsidize the provision of health care ap- perinatal care, adding two priorities for public propriate to the specificities of each of these age policies: adolescence and pregnancy. It is the legal groups. and legal framework that creates mechanisms for the implementation of fundamental rights estab- lished by the Federal Constitution, under the con- Method ception of children and adolescents as subjects of rights and as people in development. This study is part of a study called Avaliação da Literature on adolescent pregnancy is wide, Atenção ao Parto e Nascimento em Maternidades but not consensual. Studies indicate a higher fre- da Rede Cegonha. The Participatory Rapid Ap- quency of low birth weight and prematurity in praisal (PPR) technique11,12 recommended by children of adolescents, generally, justifying its the Pan American Health Organization (PAHO), occurrence due to the low socioeconomic condi- was used. PPR consists of a simple and quick ap- tions of most of them4, conditions that intensify proach to obtain information that reflects local with successive pregnancies even in this phase of conditions, from the perspective of the different life5. social actors involved with the problems. Childbearing in a woman aged 35 years All 606 public and mixed hospitals (private or more is considered advanced maternal age SUS-affiliated) that, in 2015, had a RC action (AMA) and generally have specificities in re- plan participated in the assessment. The number productive health, being more likely to develop of childbirths in these hospitals accounted for complications during pregnancy and childbirth, almost 50% of childbirths that year in the coun- especially high-risk pregnancies, such as placen- try, according to the Brazilian Information Sys- ta previa, placental abruption and intrauterine tem on Live Births (SINASC - Sistema de Infor- growth restriction6. However, unlike the move- mações sobre Nascidos Vivos). ment observed for the youngest, there are no All women who gave birth in a hospital public policies aimed specifically at the group of during the study period were considered eligible, women over 34 years of age. Specialized care is being excluded only those with severe mental configured within general guidelines and man- disorder, who did not understand Brazilian Por- uals issued by the Brazilian Ministry of Health tuguese, deaf or hospitalized in an Intermediate (MS - Ministério da Saúde), such as those aimed or Intensive Care Unit in the postpartum period. at managing high-risk pregnancies, abortion, All eligible puerperal women admitted to each prenatal and puerperium6,7, without public pol- hospital during the fieldwork period were invited icies specifically targeting the group. With the to participate in the study. More detailed infor- growing number of women postponing mother- mation on the study’s methodology is available hood8, careful obstetric care is of utmost impor- in Bittencourt et al.13. tance to minimize possible damage to the health Data collection was carried out between De- of women and babies. cember 2016 and October 2017, using five spe- Aiming at structuring and organizing mater- cific electronic forms for each data source. The nal and child health care in the country, Brazilian following data collection methods were used: 849 Ciência & Saúde Coletiva, 26(3):847-858, 2021 26(3):847-858, Coletiva, & Saúde Ciência personal interview with key informants (manag- my and episiotomy were collected from hospital ers, health professionals and puerperal women); records. data extraction from medical records, document For the analysis of obstetric practices during analysis and on-site observation. Further details childbirth, women who did not go into labor and are described in Vilella et al.14 For the present had no vaginal childbirth were excluded. Wom- analysis, information obtained through face-to- en’s sociodemographic and reproductive charac- face interviews of women after childbirth and teristics, stratified by maternal age group, were data from hospital records were used. tested using the χ2 test. The level of significance Three comparison groups were created to was set at 20%. The same procedure was used to characterize the puerperal women: adolescents compare the proportions related to assessment of (≤ 19 years), women aged 20 to 34 years, and obstetric practices in childbirth. AMA women (≥ 35 years old). Multiple logistic regression models have been The following covariables were assessed: developed to relate obstetric practices in child- women’s region of residence (north, northeast, birth with the women’s age range. The level of south, southeast and center-west); self-rated skin significance established in this analysis was 5%, color/race based on the five categories used by and Odds Ratio (OR) estimates were used con- the Brazilian Institute of Geography and Statis- sidering the effect of the sample design. ORs were tics (IBGE: white, black, brown, yellow, indige- adjusted for geographic region, skin color, edu- nous); educational level (< elementary or high cation and parity, chosen through statistical and school and more); marital status (with or with- theoretical criteria, selected because they rep- out a partner); baby’s father’s age (10-19 years or resent different sociodemographic dimensions ≥ 20 years); number of previous childbirths (0, with the potential to interfere with the incidence 1, 2, ≥ 3); use of contraceptive method (yes or of obstetric practices. The software used in the no); planned pregnancy (yes or no); early start of analyzes were SPSS 20.0 and Microsoft Excel, ver- prenatal care (1st trimester yes or no); number sion 2007. of prenatal consultations (0, 1-3, 4-6, ≥ 7); type The evaluation study was approved by the of childbirth (vaginal or cesarean section). All Ethics Committee of Universidade Federal do information about women’s sociodemographic Maranhão. All women were read an Informed and reproductive characteristics was extracted Consent Form (ICF), and a copy was given to from the interview questionnaire with puerperal those who agreed to participate in the assess- women.
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