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Choice and healthcare structure in place of birth management: a study in the north of portugal
  1. M Pereira1,
  2. S Silva1,2,3,
  3. E Pinto2,4,
  4. H Barros1,2,3
  1. 1Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal
  2. 2Institute of Public Health (ISPUP), Porto, Portugal
  3. 3Cardiovascular Research & Development Unit, Porto, Portugal
  4. 4CBQF – Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Porto, Portugal

Abstract

Place of birth has a role on labour and delivery. In Portugal, the WHO guidelines regarding parents' choice of the place of birth coexists with an official hospital based public perinatal care system. This study aimed to assess the association of maternal demographic, social and obstetrical characteristics with the option for a place of birth outside the hospital catchment area, based on the official system, defined by maternal residence.

The study assessed 5563 mothers enrolled in the Portuguese birth cohort Geração XXI assembled between April 2005 and August 2006. Agreement between mother's address and hospital catchment area was checked. Multivariate logistic regression models were fitted to quantify the association between maternal characteristics and the place of birth.

Overall, 39.2% of deliveries occurred outside hospital catchment area. Higher proportions were found among women using exclusive private prenatal care (OR=2.68; 95%CI 2.33 to 3.09), more educated (OR=1.85; 95%CI 1.59 to 2.16), self-employed (OR=1.58; 95%CI 1.08 to 2.32) and being entrepreneur and executive (OR=1.34; 95%CI 1.02 to 1.76). These deliveries were significantly less frequent among women beginning antenatal care after 12 gestational weeks (OR=0.80; 95%CI 0.65 to 0.99) and unemployed (OR=0.82; 95%CI 0.70 to 0.97).

Parental choice of the place of birth in Porto is regulated by geographical and technical criteria, but also by maternal socio-demographic characteristics and informal networks.

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