Social inequalities and women's satisfaction with childbirth care in Brazil: a national hospital-based surveyDesigualdades sociais e satisfação das mulheres com o atendimento ao parto no Brasil: estudo nacional de base hospitalar Diferencias sociales y satisfacción de las mujeres con la atención al parto en Brasil: estudio nacional de base hospitalaria

Brazil has extremely high cesarean rates. Among related factors, it has been suggested that a "culture of cesarean childbirth" (or a preference for this type of delivery) exists among Brazilian women. Our study investigates this notion. Data were collected from September 1998 to March 1999 in two maternity hospitals in Rio de Janeiro Interviews were conducted and hospital records analyzed for a random representative sample of 909 women who had just given birth (454 vaginal deliveries and 455 cesareans). In the interviews, when asked if they had wanted to have a cesarean, 75.5% replied in the negative, thus indicating that these women cannot be considered as adhering to a "culture of cesarean sections" The main complaints against cesareans were: slower and more difficult recovery (39.2%) and greater pain and suffering (26.8%). However, 17% of the sample had at some point requested a cesarean, 75% of whom during labor. Analysis revealed that the request for a cesarean section is directly proportional to time between admission to the hospital and delivery. This suggests that (in addition to being the usual means of access to tubal ligation) the actual circumstances of birthing are important factors in Brazilian women s requests for cesarean sections.

Background The inadequate management of solid waste impacts populations’ health and quality of life, and disproportionately affects developing countries. This study aims to describe a protocol for epidemiological diagnosis, the purpose being to estimate the prevalence of chronic and communicable and non communicable diseases in waste pickers, and the occupational and environmental risk factors to which these are exposed. Methods This is a cross-sectional study, based on survey design in an area of extreme social vulnerability – the largest garbage dump in Latin America. Using a multidimensional research protocol, divided in three stages : 1- The identification of the subjects, and the scheduling of tests; 2- Situational diagnosis through interviews, anthropometric evaluation, measuring blood pressure, collecting hair and nail samples to detect exposure to heavy metals and undertaking laboratory tests; 3- The return of the waste pickers to receive the test results, followed by referral to the health team and to report occupational accidents. Results One thousand twenty-five waste pickers undertook tests and interviews. The majority were women (67.0%), with 36–45 years old (45.7%), and 96.0% had children. In total, 27.3% of the participants did not attend to any school and 47.7% were educated only up to primary level. The majority of waste pickers (68.70%) reported accidents and most of them (89.69%) were related to sharp objects. The mean time working in this open dump was 15 years. According the anthropometric measure, 32.6% were overweight and 21.1% were obese. The most common reported diseases were: osteomuscular disorders (78.7%); arboviruses (28.6%); episodic diarrhea (24.9%); hypertension (24.2%); bronchitis (14.3%); intestinal worms (12.6%) and diabetes (10.1%). According to the blood tests, the values outside the reference limits were: Uric acid (23.89%); creatinine (54.06%); GGT range (16.04%); SGOT - Serum Glutamic Oxaloacetic Transaminase (5.29%); SGPT - serum Glutamic-Pyruvic Transaminase (35.52%). Conclusions This study is the first to evaluate multiple risks and diseases in the majority of waste pickers working in the largest garbage dump of a continent. These findings highlight the importance to address urgently the environmental, social and health impacts related to the management of solid waste in developmental countries to protect these workers and their families. Electronic supplementary material The online version of this article (10.1186/s12889-019-6879-x) contains supplementary material, which is available to authorized users.

This study analyzes the different representations and experiences of women from different social classes, including issues related to their relations with hospital staff in different institutional settings. This qualitative study focused on women who had experienced both types of delivery, in three maternity hospitals in Rio de Janeiro, Brazil (one public, one fully private, and another private under an outsourcing agreement with the public health system). The study showed that variations in public and private service models result in different types of delivery care and different relations with staff, and are reflected in different birthing experiences for the women. However, a critical gender perspective shows that in both cases, the service models reproduce the medicalization of childbirth and women's submission as objects in the birthing process. Although this is manifested in different ways in the three groups, the end result is to reduce the range of care and the possibility of women's empowerment during childbirth.

Resumo ObjetivoAvaliar a qualidade da atenção durante o processo de trabalho de parto de acordo com normas da Organização Mundial de Saúde. Métodos Trata-se de estudo do tipo caso-controle, realizado em duas maternidades: pública e conveniada com o Sistema Único de Saúde, no Município do Rio de Janeiro. A amostra foi composta por 461 mulheres na maternidade pública (230 partos vaginais e 231 cesáreas) e por 448 mulheres na maternidade conveniada (224 partos vaginais e 224 cesáreas). De outubro de 1998 a março de 1999, foram realizadas entrevistas com puérperas e revisão de prontuários. Foi construído escore sumarizador da qualidade do atendimento. Resultados Observou-se baixa freqüência de algumas práticas que devem ser encorajadas, como presença de acompanhante (1% na maternidade conveniada, em ambos os tipos de parto), deambulação durante o trabalho de parto (9,6% das cesáreas na maternidade pública e 9,9% dos partos vaginais na conveniada) e aleitamento na sala de parto (6,9% das cesáreas na maternidade pública e 8,0% das cesáreas na conveniada). Práticas comprovadamente danosas e que devem ser eliminadas como uso de enema (38,4%), tricotomia, hidratação venosa de rotina (88,8%), uso rotineiro de ocitocina (64,4%), restrição ao leito durante o trabalho de parto (90,1%) e posição de litotomia (98,7%) para parto vaginal apresentaram alta freqüência. Os melhores resultados do escore sumarizador foram obtidos na maternidade pública. Conclusões As duas maternidades apresentam freqüência elevada de intervenções durante a assistência ao parto. A maternidade pública, apesar de atender clientela com maior risco gestacional, apresenta perfil menos intervencionista que maternidade conveniada. Procedimentos realizados de maneira rotineira merecem ser discutidos à luz de evidências de seus benefícios.

Brazil has one of the world's highest cesarean section rates. Contributing factors include the organization of obstetric practice, physicians' attitudes, and women's preferences and decisions. This study aimed to identify factors associated with cesarean sections in a public maternity hospital in Rio de Janeiro. A case-control study was conducted with 231 cesarean sections (cases) and 230 vaginal deliveries (controls). Hierarchical logistic regression analysis was performed, based on a conceptual model. Factors associated with increased odds of cesarean section were: primiparity; mother's age 20-34; last birth by cesarean; cervical dilatation < 3cm at admission; patient request; daytime birth; male attending obstetrician; obstetrician on duty for more than 24 hours a week; obstetrician with private practice; gestational hypertension; non-cephalic presentation; and gestational age > 41 weeks. Factors associated with lower odds of cesarean were: gestational age < 37 weeks; leaving home with signs of labor, use of oxytocin; and amniotomy. In this hospital, interventions aimed to modify the above-mentioned factors can help lower the cesarean rate.

The need for clearly-defined health research policies

In Brazil, where birthing generally occurs in hospitals and under the care of obstetricians, the incorporation of nurses is a strategy that has been used recently in an attempt to improve obstetric care. This study, conducted in two maternity hospitals in Rio de Janeiro, focuses on representations of obstetricians and nurses regarding teamwork and analyzes how the dimensions of power, cooperation/conflict, and technical autonomy are permeated by dualistic conceptions which influence the quality of health care for women during childbirth. On the one hand, the results show a consensus regarding the advantages of professional cooperation in the improvement of health care, assuming the existence of a clear definition of professional roles. At the same time, conflicts regarding therapeutic conduct during the birth process reflect the professionals' perceptions of autonomy and the influence of professional hierarchies, in which obstetric care is seen to depend on the "objective observation" of the women giving birth. The degree of conflict is differentiated according to the institutional context and related to dualistic conceptions such as objective/subjective, rational/emotional, and male/female.