Restricting the timing of Elective CS: evidence from Brazil

Abstract

Brazil has one of the highest Cesarean Section (CS) rates in the world. It is a share of 58.3% reported by the Living Births Information System (SINASC) 2015-2017. It is well above the maximum rate of 15% recommended by the World Health Organization (WHO). In this paper, we estimate impacts and unintended consequences of the Resolution 2,144 from the Federal council of Medicine (CFM) on outcomes of Low Risk First Born births (LRFB). The Resolution introduces a minimum of 39th weeks of gestation for Elective CS. Elective CS before the 39th week rate dropped 2.78 percentage points, which is statistically significant and equivalent to a 24% decrease in this outcome’s mean. We also find increases in birth’s time length: the percentage of births happening before the 39th week decreased 2.34 percentage points, which is a decrease of 6% in its average. Our results suggest that Elective CS’s were postponed from the 37-38th week to after the begin of the 39th week. We show that the policy had an unintended consequence once it seems to have changed the way potential spontaneous Natural Deliveries are anticipated from weekends to weekdays through Scheduled CS.

Factors Related to the Performance of Cesarean Sections in the State of Minas Gerais Between 2010 and 2020

“…For this reason, in 2016, the Federal Council of Medicine published Resolution, number: 2,144/2016 determining that elective cesarean sections must only occur after 39 weeks, after clarifying the risks and benefits of each type of birth for the pregnant woman. 12 .…”

“…Rising cesarean section rates don't just have a financial impact, as shown by Entringer, Pinto and Gomes 12 , who found costs up to 38% higher in cesarean sections than in vaginal births. The increase in cesarean sections also brings risks to the parturient-neonate binomial, since maternal mortality is higher in surgical births when compared to vaginal births.…”