Introduction Excessive caesarean sections can be considered a public health problem, involving not only maternal-fetal consequences, but also generating higher costs and burdening the public and private sector. Interventions in Brazil have been taking place for some years to improve obstetric care, such as the Parto Adequado Project (PAP), a project aimed at improving the quality of delivery and birth care, which provided institutional, scientific, and methodological support to selected hospitals.
MethodThis is a descriptive, retrospective longitudinal study based on the analysis of data from 34 public and private health establishments participating in the first phase of the PAP, between 2014 and 2018, based on data contained in the Painel de Monitoramento de Nascidos Vivos and Painel de Monitoramento de Nascidos Vivos segundo Classificação de Risco Epidemiológico (Grupos de Robson), both databases of the Sistema de Informações sobre Nascidos Vivos (SINASC). Individualizing each institution by year evaluated with the respective numbers of births and numbers of caesarean sections performed, distributing them among the ten groups of the Robson's classification, and separated into public and non-public institutions, it was possible to analyze the variation of each Robson's group over the years studied in each hospital participating in this research. Data on births and caesarean sections from hospitals in Brazil with similar characteristics to those participating in phase 1 of the PPA were collected, in order to make comparisons between the two groups of hospitals (participating and non-participating in the first phase of the PPA). Results During the study period, a reduction in the percentage of caesarean sections from 70.49% to 62.16% in public hospitals and from 81.86% to 73.09% in participating non-public hospitals was observed. Analysing the results from the Robson's classification, the reduction in groups 1, 2, 3 and 4 grouped was from 58.31% to 52.83% in public hospitals and from 65.69% to 57.85% in non-public hospitals. The average caesarean rate of project participants decreased from 62.14% in 2014 to 55.34% in 2018. When