Cesarean-section Rates in Brazil from 2014 to 2016: Cross-sectional Analysis Using the Robson Classification

Abstract

Objective To obtain cesarean-section (CS) rates according to the Robson Group Classification in five different regions of Brazil. Methods A descriptive epidemiological study using data from secondary birth records from the Computer Science Department of the Brazilian Unified Health System (Datasus, in Portuguese) between January 1st, 2014, and December 31st, 2016, including all live births in Brazil. Results The overall rate of CS was of 56%. The sample was divided into 11 groups, and vaginal births were more frequent in groups 1 (53.6%), 3 (80.0%) and 4 (55.1%). The highest CS rates were found in groups 5 (85.7%), 6 (89.5%), 7 (85.2%) and 9 (97.0%). The overall CS rate per region varied from 46.2% in the North to 62.1% in the Midwest. Group 5 was the largest obstetric population in the South, Southeast and Midwest, and group 3 was the largest in the North and Northeast. Group 5 contributed the most to the overall CS rate, accounting for 30.8% of CSs. Conclusion Over half of the births in Brazil were cesarean sections. The Midwest had the highest CS rates, while the North had the lowest. The largest obstetric population in the North and in the Northeast was composed of women in group 3, while in the South, Southeast and Midwest it was group 5. Among all regions, the largest contribution to the overall CS rate was from group 5.

Variations in cesarean and repeated cesarean section rates in Brazil according to gestational age at birth and type of hospital

“…These regions have the largest number of people with better socioeconomic conditions, who use private hospitals more often -facilities that present the highest cesarean section rates in the country 7,9,34 . Previous studies also reported higher prevalence of cesarean sections in more developed regions of Brazil 7,9,34,35,36 . Hopkins et al 35 , when assessing data from the Brazilian National Household Sample Survey (PNAD), identified a 45% higher chance of cesarean section among women living in the Southeast Region, a 65% higher chance among women living in the South Region, and a 73% higher chance among women living in the Central-West Region of Brazil.…”

Cross-cultural adaptation and psychometric evaluation of the Brazilian Portuguese version of the childbirth experience questionnaire

“…Among the study population, only 39.3 and 16.9% of the participants received pain relief, including pharmacological or nonpharmacological methods, respectively. it is important to note that cesarean section was the most common mode of delivery in Brazil, in the 2014-2016 period, comprehending 56% of all births [21]. Negative perceptions of vaginal delivery, related to the fear of labor pain, and also issues such as the fear of not being able to give birth and low quality of care were the aspects most often cited to justify the preference for caesarean section for Brazilian women [22].…”

Variações das taxas de cesariana e cesariana recorrente no Brasil segundo idade gestacional ao nascer e tipo de hospital

“…Essas regiões concentram a maior parcela de pessoas com melhores condições socioeconômicas, que, por sua vez são responsáveis pela maior utilização do setor privado de saúde, em que se concentram as maiores taxas de cesariana no país 7,9,34 . Estudos anteriores também evidenciaram maiores prevalências de cesarianas em regiões mais desenvolvidas do Brasil 7,9,34,35,36 . Hopkins et al 35 , utilizando dados da Pesquisa Nacional por Amostra de Domicílios (PNAD) identificaram chance 45% maior de cesariana para mulheres residentes no Sudeste, 65% maior para residentes no Sul e 73% maior para residentes no Centro-oeste do país.…”

“…Além disso, é possível observar grande desigualdade na distribuição das taxas de cesariana no país, sendo maiores em regiões mais desenvolvidas, em mulheres com idade maior ou igual a 35 anos, de cor da pele branca e com maior nível de escolaridade 7,8,9 . As taxas também se distribuem diferentemente de acordo com as instituições hospitalares existentes (hospitais públicos, financiados pelo Governo Federal; hospitais mistos, financiados tanto pelo setor público quanto pelo setor privado; e hospitais privados), sendo mais prevalentes nos hospitais privados, que possuem maiores prevalências de nascimentos de pré-termos tardios (34)(35)(36) semanas) e termos precoces (37-38 semanas), em comparação aos hospitais públicos 10,11 .…”