Risk factors for cesarean section by category of health service

Abstract

OBJECTIVE:To analyze the rate of cesarean section and differences in risk factors by category of health service, either public or private. METHODS:A cross-sectional study was carried out including all pregnant women in labor admitted to hospitals in the city of Rio Grande, Southern Brazil, between January 1 and December 31, 2007. A pre-coded and pretested questionnaire was used to collect on social, demographic, obstetric and newborn care information. Two regression models were constructed: one for public users and the other one for private ones. Poisson regression was used in each model in the multivariate analysis. Prevalence rates and 95% confi dence intervals were calculated for each adjusted factor. RESULTS:The rate of cesarean section was 43% and 86% among public and private users. Sociodemographic factors and twin births have a more signifi cant impact among public users as well as number of pregnancies (25% vs. 13% reduction in public and private users, respectively) and previous cesarean section (86% vs. 24% increase in public and private users, respectively). Prenatal care visits and hospital admissions affected the outcome only in women users of public services. CONCLUSIONS:Cesarean section rates were high in both groups studied, but it was twice as high among women cared in the private sector. Associated factors differ in magnitude by category of service used. Some of the reasons associated with this high rate are related to health service characteristics.22,25 A recent study of the Brazilian National Supplemental Health Agency (ANS, which regulates private insurance) reported that cesarean section rates among privatelyinsured women were as high as 80% in 2006 a while it is was 26% in the public Brazilian National Health System (SUS), b a rate that is high but closer to that recommended.Although the same surgical procedure is performedand sometimes they are performed by the same doctors RESUMO OBJETIVO: Analisar a taxa de cesárea e fatores associados à sua ocorrência segundo serviço de saúde utilizado, público ou privado. MÉTODOS:Foi realizado estudo transversal entre 1º de janeiro e 31 de dezembro de 2007 com todas as gestantes que deram à luz nos hospitais da cidade de Rio Grande, RS. As gestantes foram entrevistadas, utilizando-se um questionário testado e pré-codifi cado com questões sociodemográfi cas, obstétricas e relacionadas ao recém-nascido. Foram desenvolvidos dois modelos de predição, um para as gestantes internadas pelo Sistema Único de Saúde (público) e outro para as gestantes internadas em serviços privados. Em cada modelo foi realizada uma análise multivariada utilizando a regressão de Poisson, calculando-se as razões de prevalência e seus respectivos intervalos com 95% de confi ança. RESULTADOS:A taxa de cesárea para o grupo público foi 43% enquanto no grupo privado foi 86%. Os fatores sociodemográfi cos e o parto gemelar foram mais importantes no modelo público, assim como o número gravidezes (redução de 25% vs. 13% no grupo privado) e cesárea prévia (incremento de 86% vs. ...

Factors associated to the type of childbirth in public and private hospitals in Brazil

“…When stratified by the type of service, the rates were 36% among the patients from the National Health System and 81% in the private service. Similarly, another study 15 indicated a cesarean section rate of 43% for the public group and 86% for the private group. In addition, a recent study was conducted in Maringá city to assess the temporal tendency of childbirth according to funding source, 5 during 11 years of observation.…”

“…15 Some associations seem to maintain even among patients who perform prenatal care in public units. In a study carried out with 322 pregnant women performing prenatal care at a Basic Health Unit in Rio de Janeiro, found an association for the most advanced age group (OR = 4.82) and the married women (OR = 3.05).…”

Público versus privado: avaliando a assistência à gestação e ao parto no extremo sul do Brasil

“…Era de se esperar o oposto, visto que gestantes do setor privado apresentam melhor nível de escolaridade e renda. 5,14 Em relação ao VDRL, o argumento de que, ao realizar exame de sangue, a mãe não sabe para quais doenças será realizado o teste, pode auxiliar na explicação da baixa cobertura para ambos os grupos, mas não justifica a diferença observada entre eles. A realização de VDRL e de exame comum de urina permite identificar precocemente sífilis e infecção do tato urinário, respectivamente.…”

Factors associated with high Cesarean deliveries in China and Brazil - A Call for reducing elective surgeries in moving towards Universal Health Coverage

“…Cesarean delivery rate almost doubles among women seeking care from private providers compared to women delivering in the public sector [39] .…”

“…Since the mid-1990s, 90% of the births are institutional, and 80% of the deliveries are financed by the Brazilian national health system, the Sistema Único de Saúde (SUS) [36] . Data for 2006 indicate that the overall rate of Cesarean sections in the SUS was 30.1% [37] , ranging from 18.9% [32] to 36% [36,38] , with some studies reporting rates as high as 43% throughout the years [39] .…”