Patterns of deliveries in a Brazilian birth cohort: almost universal cesarean sections for the better-off

Abstract

OBJECTIVE: To describe the patterns of deliveries in a birth cohort and to compare vaginal and cesarean section deliveries. METHODS: All children born to mothers from the urban area of Pelotas, Brazil, in 2004, were recruited for a birth cohort study. Mothers were contacted and interviewed during their hospital stay when extensive information on the gestation, the birth and the newborn, along with maternal health history and family characteristics was collected. Maternal characteristics and childbirth care financing - either private or public healthcare (SUS) patients - were the main factors investigated along with a description of C-sections distribution according to day of the week and delivery time. Standard descriptive techniques, Χ² tests for comparing proportions and Poisson regression to explore the independent effect of C-section predictors were the methods used. RESULTS: The overall C-section rate was 45%, 36% among SUS and 81% among private patients, where 35% of C-sections were reported elective. C-sections were more frequent on Tuesdays and Wednesdays, reducing by about a third on Sundays, while normal deliveries had a uniform distribution along the week. Delivery time for C-sections was markedly different among public and private patients. Maternal schooling was positively associated with C-section among SUS patients, but not among private patients. CONCLUSIONS: C-sections were almost universal among the wealthier mothers, and strongly related to maternal education among SUS patients. The patterns we describe are compatible with the idea that C-sections are largely done to suit the doctor's schedule. Drastic action is called for to change the current situation.

Cesarean section on demand: a population-based study in Southern Brazil

“…There are numerous studies conducted in Brazil showing that these pregnant women are the ones that present the lowest need to be submitted to cesarean section. 5,16,17 In this study, the presence of comorbidity in the gestational period decreases the probability performing a cesarean section on demand. Mothers who referred in receiving treatment for hypertension, diabetes and/or depression presented PR=0.65 (CI95%: 0.43-1.00), indicating that the presence of these pathologies decreases the probability of cesarean section on demand.…”

“…5,[15][16][17] The results presented in this study show that, even among those who performed cesarean sections, know it is of lower risk, there is a group of lower risk, even if the women are submitted to a cesarean section on demand. This shows the necessity for strategies to inhibit this practice.…”

“…The hospitalization for childbirth in the private sector is part of a process that reveals the acquisition power of the households. 5 This process begins with the prenatal care consultations, passes by hospitalization and culminates with the payment for the obstetrician. There are numerous studies conducted in Brazil showing that these pregnant women are the ones that present the lowest need to be submitted to cesarean section.…”

“…3.4 As a rule, this procedure is performed among those with lower risk of complications during pregnancy and childbirth. 5 Within this abusive practice, there are significant proportion of women in a deliberated and assumed way asking the obstetrician to perform a cesarean section, regardless of their actual need. Hence the title "cesarean section on demanad".…”

“…In relation to the occurrence of cesarean sections in the country, there is consensus that are carried out a lot, especially among those who present the lowest risk of complications during childbirth. 5,[7][8][9] The aim of this study was to measure the prevalence and identify factors associated to the occurrence of cesarean section on demand between mothers who had children in 2007 in the municipality of Rio Grande, RS.…”