O objetivo deste artigo é descrever os fatores referidos para a preferência pelo tipo de parto no início da gestação e reconstruir o processo de decisão pelo tipo de parto no Brasil. Dados de uma coorte de base hospitalar nacional com 23.940 puérperas, realizada em 2011-2012, foram analisados, segundo fonte de pagamento do parto e paridade, com utilização do teste χ2. A preferência inicial pela cesariana foi de 27,6%, variando de 15,4% (primíparas no setor público) a 73,2% (multíparas com cesariana anterior no setor privado). O principal motivo para a escolha do parto vaginal foi a melhor recuperação desse tipo de parto (68,5%) e para a cesariana o medo da dor do parto (46,6%). Experiência positiva com parto vaginal (28,7%), parto cesáreo (24,5%) e realização de laqueadura tubária (32,3%) foram citadas por multíparas. Mulheres do setor privado apresentaram 87,5% de cesariana, com aumento da decisão pelo parto cesáreo no final da gestação, independentemente do diagnóstico de complicações. Em ambos os setores, a proporção de cesariana foi muito superior ao desejado pelas mulheres.

A influência das quedas na qualidade de vida de idososThe influence of falls on the quality of life of the aged

This study evaluated data on the incidence of maternal near miss identified on World Health Organization (WHO) criteria from the Birth in Brazil survey. The study was conducted between February 2011 and October 2012. The results presented are estimates for the study population (2,337,476 births), based on a sample of 23,894 women interviewed. The results showed an incidence of maternal near miss of 10.21 per 1,000 live births and a near-miss-to-mortality ratio of 30.8 maternal near miss to every maternal death. Maternal near miss was identified most prevalently by clinical criteria, at incidence of 5.2 per 1,000 live births. Maternal near miss was associated with maternal age 35 or more years (RR=1.6; 95%CI: 1.1-2.5), a history of previous cesarean delivery (RR=1.9; 95%CI: 1.1-3.4) and high-risk pregnancy (RR=4.5; 95%CI: 2.8-7.0). incidence of maternal near miss was also higher at hospitals in capital cities (RR=2.2; 95%CI: 1.3-3.8) and those belonging to Brazil's national health service, the Brazilian Unified National Health System (SUS) (RR=3.2; 95%CI: 1.6-6.6). Improved quality of childbirth care services can help reduce maternal mortality in Brazil.

This paper describes the sample design for the National Survey into Labor and Birth in Brazil. The hospitals with 500 or more live births in 2007 were stratified into: the five Brazilian regions; state capital or not; and type of governance. They were then selected with probability proportional to the number of live births in 2007. An inverse sampling method was used to select as many days (minimum of 7) as necessary to reach 90 interviews in the hospital. Postnatal women were sampled with equal probability from the set of eligible women, who had entered the hospital in the sampled days. Initial sample weights were computed as the reciprocals of the sample inclusion probabilities and were calibrated to ensure that total estimates of the number of live births from the survey matched the known figures obtained from the Brazilian System of Information on Live Births. For the two telephone follow-up waves (6 and 12 months later), the postnatal woman's response probability was modelled using baseline covariate information in order to adjust the sample weights for nonresponse in each follow-up wave.

Trajetória das mulheres na definição pelo parto cesáreo: estudo de caso em duas unidades do sistema de saúde suplementar do estado do Rio de Janeiro