Effects of elective cesarean sections on perinatal outcomes and care practices

Abstract

Objectives: to verify the effects of elective cesarean sections on perinatal outcomes and care practices, as compared to vaginal deliveries. Methods: cohort study with 591 mothers and their babies, developed in a medium-sized city in the state of São Paulo, Brazil. Data were collected from hospital records and by interviews at the neonatal screening unit in the city from July 2015 to February 2016. Data regarding childbirth, newborns, sociodemography, and current gestational history were obtained from each mother. The associations of interest were evaluated with Cox regression analyses adjusted for the covariates identified through the results of bivariate analyses presenting a statistical significance level ofp<0.20. In adjusted analyzes, relationships were considered significant ifp<0.05, with relative risk being considered as the measure of effect. Results: if compared to women who had vaginal deliveries, those who were submitted to elective cesarean sections were at a higher risk of not having skin-to-skin contact with their babies in the delivery room, of not breastfeeding in the first hour of life, and of having their babies hospitalized in a neonatal unit. Conclusions: reducing the number of elective cesarean sections is essential to foster good neonatal care practices and reduce negative neonatal outcomes.

First hour of life and COVID-19 from the view of obstetric nurses:adescriptivestudy

“…Regardless of the suspicion or confirmation of infection by Sars-CoV-2, the possibility of skinto-skin contact and breastfeeding at birth were shown to be conditioned, above all, on the type of delivery, with cesarean being identified as one of the obstacles to maintaining this practices, corroborating findings in the literature (11)(12)(13)(14) .…”

“…It is noticeable that certain factors can directly influence the continuity of skin-to-skin contact and the guarantee of the golden hour. In the obstetric center environment, many elements make it difficult to maintain the golden hour, such as instability of the mother's clinical conditions, discomfort during the closing of the surgical in-ONLINE BRAZILIAN JOURNAL OF NURSING, 21 Suppl 2:e20226549 cision, lethargic effects of anesthetics, nausea, and unpreparedness of the obstetric team (11) . In addition to these, other factors, such as first care, exams, teamwork, and institutional routines, can interfere with skin-to-skin contact (14) .…”

“…Despite the above, guidance and efforts are needed so that skin-to-skin contact is encouraged during the first hour of life, also in cases of cesarean sections, considering the specificities faced during the pandemic, as this process brings both benefits to the woman and the newborn. Furthermore, it provides an intimate moment, with comfort for both mother and child, generates heat stimuli for better adaptation, prevention of pain, healthy development of the baby, and aid in the interaction and creation of a bond between mother and child, a factor that is harmed by cesarean section, since oxytocin, prolactin, adrenaline and noradrenaline hormones, which facilitate this relationship, are not released in the same way that occurs in a vaginal delivery (11)(12)(13)(14)(15)(16) .…”

Dispositivo Materno e Parto: uma análise da interface de gênero e saúde mental nos relatos de mulheres do documentário “O renascimento do parto I”

“…Atualmente, verifica-se que muitas cesáreas eletivas são marcadas sem necessidade prévia, aumentando o risco de morte da mãe e/ou do bebê, além de reduzir o contato pele a pele dela com seu bebê na sala de parto, de não o amamentar nas primeiras horas de vida e do bebê precisar ser internado em unidade neonatal (Ferrari, 2020).…”

Perfil de cesarianas de uma maternidade do interior do Rio Grande do Sul

“…Bebês nascidos por cesariana têm mais chance de necessidade de intervenções imediatas, como estabelecimento de vida extrauterina, alguns estudos trazem que a duração do tempo de internação do recém-nascido de cesariana é maior em relação ao recém-nascido de parto normal, assim como o risco de necessidade de internação em Unidade de Terapia Intensiva (UTI). Há também influência das recomendações da OMS, como interrupção ou privação de contato pele a pele, início tardio do aleitamento materno e clampeamento do cordão umbilical (Ferrari, 2020).…”