Caesarean birth rates in public and privately funded hospitals: a cross-sectional study

Abstract

OBJECTIVE To examine maternal and obstetric factors influencing births by cesarean section according to health care funding.METHODS A cross-sectional study with data from Southeastern Brazil. Caesarean section births from February 2011 to July 2012 were included. Data were obtained from interviews with women whose care was publicly or privately funded, and from their obstetric and neonatal records. Univariate and multivariate analyses were conducted to generate crude and adjusted odds ratios (OR) with 95% confidence intervals (95%CI) for caesarean section births.RESULTS The overall caesarean section rate was 53% among 9,828 women for whom data were available, with the highest rates among women whose maternity care was privately funded. Reasons for performing a c-section were infrequently documented in women’s maternity records. The variables that increased the likelihood of c-section regardless of health care funding were the following: paid employment, previous c-section, primiparity, antenatal and labor complications. Older maternal age, university education, and higher socioeconomic status were only associated with c-section in the public system.CONCLUSIONS Higher maternal socioeconomic status was associated with greater likelihood of a caesarean section birth in publicly funded settings, but not in the private sector, where funding source alone determined the mode of birth rather than maternal or obstetric characteristics. Maternal socioeconomic status and private healthcare funding continue to drive high rates of caesarean section births in Brazil, with women who have a higher socioeconomic status more likely to have a caesarean section birth in all birth settings.

Modelos de assistência obstétrica na Região Sul do Brasil e fatores associados

“…Soma-se a isso a constituição de um modelo com mulheres de maior escolaridade e que, por esse motivo, deveriam ter maior acesso à informação de qualidade e à contestação baseada em cientificidade por parte dos profissionais, para a não adoção das melhores práticas, ou seja, a decisão por uma cesárea 15 . Ademais, deve-se destacar o caso das mulheres que foram acompanhadas no pré-natal por profissional médico e que tiveram a continuidade do atendimento no momento do nascimento, característica que promove uma relação de confiança.…”

Pattern of Live Births in Rio de Janeiro State, Brazil, According to Robson Groups and the Kotelchuck Index Classification - 2015/2016

“…[4][5][6] In addition, in Brazil, cesarean deliveries in private sector facilities (privately-owned, either government or private sector insured) is much higher than in public health facilities. 7,8 Also, a positive association between the socioeconomic status of mothers and cesarean section rates has been detected in studies, especially among women who had private health services, possibly due to the scarcity of options for vaginal delivery in the private health sector. 8 Therefore, socioeconomic status seems to be an important predictor of C-sections.…”

“…7,8 Also, a positive association between the socioeconomic status of mothers and cesarean section rates has been detected in studies, especially among women who had private health services, possibly due to the scarcity of options for vaginal delivery in the private health sector. 8 Therefore, socioeconomic status seems to be an important predictor of C-sections.…”

Isthmocele: From Risk Factors to Management

“…3,4 A higher maternal socioeconomic status seems to be associated with a greater likelihood of CS. 5 The World Health Organization (WHO) states that the optimal CS rate is around 15%. 6 Cesarean incisions usually heal without consequences, but there is always the possibility of complications.…”