Companion and Type of Delivery: Inequalities in Brazil Revealed by the National Health Survey - 2019

Birth companion is a contributory factor for humanization of labor, influencing favorable maternal and perinatal outcomes. Objective: To describe maternal and perinatal aspects of pregnancies that ended either with or without the participation of a companion during the labor period.

This cross-sectional descriptive study was conducted in Brazil using data collected from the National Health Survey (PNS-2019). Participants were Brazilian women aged 15 to 49 years who had experienced pregnancy at some point in their lives and whose most recent delivery occurred between July 2017 and July 2019. Prevalence and 95% confidence intervals (95% CI) were calculated to characterize maternal and perinatal aspects according to the participation of a companion.

The target population was estimated at 5.3 million women who underwent either cesarean section (54.58%) or vaginal delivery (45.42%) between July 2017 and July 2019. The prevalence of companion support was high (84.98%), with similar rates observed for cesarean section (85.52%) and vaginal delivery (84.33%). Private health insurance coverage, the number of prenatal appointments, and the place of the last delivery were associated with differences in companion participation rates in both delivery methods. In cesarean deliveries, the presence of complications during delivery and the number of postpartum appointments also influenced companion participation rates. In vaginal deliveries, older maternal age, higher parity, and episiotomy were associated with companion participation rates.

The participation of a companion during labor is high and independent of the delivery method; however, socioeconomic inequalities and unequal access to quality health services persist. Initiatives to strengthen policies supporting the humanization of labor and childbirth, and to guarantee the right to a companion during delivery, particularly within Brazil's Unified Health System (SUS), are essential for expanding and making the support more equitable for women in labor.