Systematic review and meta‐analysis of studies on delivery preferences in Brazil

Reiter, Marilia; Betrán, Ana Pilar; Marques, Fernando K.; Torloni, Maria Regina

doi:10.1002/ijgo.12570

Cited by 17 publications

(21 citation statements)

References 38 publications

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“…The rate of cesarean was found to be 58.8% and 60.7% in the southeastern and southern regions, respectively. A previous meta‐analysis of 28 studies and more than 31 000 Brazilian women found that, on the basis of studies mainly conducted during the postpartum period, approximately 27% of the pregnant women reported to prefer cesarean . Worldwide, the rate of cesarean has been increasing over the past few decades even in high‐income counties, and is now very high in Brazil.…”

Section: Discussionmentioning

confidence: 99%

Spatial distribution of Robson 10‐group classification system and poverty in southern and southeastern Brazil

Brunherotti

Prado

Martinez

2019

Intl J Gynecology & Obste

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Objective To assess the spatial distribution of the Robson 10‐group classification system (TGCS) and poverty in southeastern and southern regions of Brazil in 2016. Methods An ecologic study based on public data from the Brazilian Information System on Live Births and the Brazilian Institute of Geography and Statistics, including 1 519 289 (53.2%) of all live‐born neonates in Brazil between January and December 2016. Statistical analysis used Bayesian modelling with spatial distribution following an autoregressive conditional structure, and Moran index. Results In 2016, the percentage of live‐born neonates delivered by cesarean was 58.8% and 60.7% in the southeastern and southern regions, respectively. Robson groups 1 and 3, involving spontaneous labor, were related to regions with higher poverty (Moran index, 0.36 and 0.44, respectively), whereas groups 2 and 5, involving cesarean delivery, were related to poorer regions (Moran index, 0.56 and 0.45, respectively). Conclusion The frequencies of each group of the Robson TGCS were heterogeneously distributed in the geographic space owing to important associations with the proportion of poverty in the different regions. Actions are needed to develop the poorest regions in order to minimize existing disparities.

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Section: Discussionmentioning

confidence: 99%

Spatial distribution of Robson 10‐group classification system and poverty in southern and southeastern Brazil

Brunherotti

Prado

Martinez

2019

Intl J Gynecology & Obste

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“…In the Birth Brazil Survey, 70.8% of pregnant women surveyed stated that they prefer a vaginal birth, and a metanalysis review with 28 different Brazilian studies found an overall prevalence of 72.8% preference for a vaginal birth (38,65). However, 40% expected to have a C-section when arriving at the hospital to give birth (76).…”

Section: Creating Tailored Health Education Interventionsmentioning

confidence: 99%

“…Different authors have discussed the increased rates of cesarean in the private sector, creating a paradox of care, in which low-risk women have more interventions (35)(36)(37). Studies show that, frequently, the relationship between women and obstetricians is asymmetrical and physician-centered, with no place for women's choices and preferences (16,37,38). Therefore, Brazil's maternal health care model is considered a technocratic model of childbirth (39,40).…”

mentioning

confidence: 99%

Changes in perceived knowledge about childbirth among pregnant women participating in the Senses of Birth Intervention in Brazil: A cross-sectional study

Fernandes

Lansky

Oliveira

et al. 2019

Preprint

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Background: Senses of Birth (SoB) is a health education intervention in Brazil that addresses reproductive rights, the benefits and risks of normal birth and cesarean, and use of evidence-based practices (EBP) during labor and childbirth, aiming to reduce unnecessary cesareans in the country. This study evaluates the impact of the SoB intervention on pregnant women's perceived knowledge about normal birth, cesarean, and use of EBP in childbirth. Method: 1,287 pregnant women answered a structured questionnaire, immediately after their visit to the exhibition, between March 2015 and March 2016, in four cities. To identify the impact of the intervention on women's perceived knowledge and possible association with socioeconomic and demographic characteristics, statistical analyses were performed including paired T-tests, ANOVA, and logistic and linear regressions. Results: The mean score (MS) of perceived knowledge after the intervention was higher than the mean score before experiencing the SoB for all three knowledge domains: Normal Birth (MS Before= 3.71 x MS After= 4.49), Cesarean (MS Before= 3.54 x MS After= 4.26) and EBPs (MS Before= 3.14 x MS After= 4.14). The results suggest that SoB intervention was more effective for low income women (B = 0.206; p < 0.001 for EBP), women without private health insurance (OR 2.47, 95% CI: 1.49-4.09 for normal birth), women with private prenatal care (OR 2.42, 95% CI: 1.59-3.66 for normal birth), women experiencing their first pregnancy (OR 1.92, 95% CI: 1.31-2.82 for EBP; OR 1.37, 95% CI: 1.03-1.84 for normal birth; OR 1.37, 95% CI: 1.03-1.84 for cesarean), and women in their first or second trimester at the time of the intervention (OR 1.64, 95% CI: 1.13-2.39 for EBP; OR 1.48, 95% CI: 1.11-1.97 for normal birth; OR 1.85, 95% CI: 1.40-2.41 for cesarean). Conclusion: The study showed opportunities to increase knowledge among Brazilian pregnant women for the three knowledge domains, and a need to focus the discussion on how to achieve a positive experience of birth using EBP. The intervention gains relevance considering the lack of evidence of the efficacy of non-clinical interventions to reduce unnecessary cesareans in middle and low-income countries targeting women.

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“…Additional reasons for the high rates of cesarean in Brazil might be related to the model of care and physicians' beliefs and behavior. Studies show that, frequently, the relationship between women and obstetricians is asymmetrical and physician centered, with no place for women's choices and preferences (27,39,40).…”

Section: Introductionmentioning

confidence: 99%

Changes in perceived knowledge about childbirth among pregnant women participating in the Senses of Birth Intervention in Brazil: A cross-sectional study

Fernandes

Lansky

Oliveira

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Senses of Birth (SoB) is a health education intervention in Brazil that addresses reproductive rights, the benefits and risks of normal birth and cesarean, and use of evidence-based practices (EBP) during labor and childbirth, aiming to reduce unnecessary cesareans in the country. This study evaluates the impact of the SoB intervention on pregnant women’s perceived knowledge about normal birth, cesarean, and use of EBP in childbirth. Method: 1,287 pregnant women answered a structured questionnaire, immediately after their visit to the exhibition, between March 2015 and March 2016, in four cities. To identify the impact of the intervention on women’s perceived knowledge and possible association with socioeconomic and demographic characteristics, statistical analyses were performed including paired T-tests, ANOVA, and logistic and linear regressions. Results: The mean score (MS) of perceived knowledge after the intervention was higher than the mean score before experiencing the SoB for all three knowledge domains: Normal Birth (MS Before= 3.71 x MS After= 4.49), Cesarean (MS Before= 3.54 x MS After= 4.26) and EBPs (MS Before= 3.14 x MS After= 4.14). The results suggest that SoB intervention was more effective for low income women (B = 0.206; p < 0.001 for EBP), women without private health insurance (OR 2.47, 95% CI: 1.49- 4.09 for normal birth), women with private prenatal care (OR 2.42, 95% CI: 1.59- 3.66 for normal birth), women experiencing their first pregnancy (OR 1.92, 95% CI: 1.31-2.82 for EBP; OR 1.37, 95% CI: 1.03-1.84 for normal birth; OR 1.37, 95% CI: 1.03-1.84 for cesarean), and women in their first or second trimester at the time of the intervention (OR 1.64, 95% CI: 1.13-2.39 for EBP; OR 1.48, 95% CI: 1.11-1.97 for normal birth; OR 1.85, 95% CI: 1.40-2.41 for cesarean). Conclusion: The study showed opportunities to increase knowledge among Brazilian pregnant women for the three knowledge domains, and a need to focus the discussion on how to achieve a positive experience of birth using EBP. The intervention gains relevance considering the lack of evidence of the efficacy of non-clinical interventions to reduce unnecessary cesareans in middle and low-income countries targeting women.

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Systematic review and meta‐analysis of studies on delivery preferences in Brazil

Abstract: Overall, most lay persons in Brazil did not prefer to deliver by cesarean.

Cited by 17 publications

References 38 publications

Spatial distribution of Robson 10‐group classification system and poverty in southern and southeastern Brazil

Spatial distribution of Robson 10‐group classification system and poverty in southern and southeastern Brazil

Changes in perceived knowledge about childbirth among pregnant women participating in the Senses of Birth Intervention in Brazil: A cross-sectional study

Changes in perceived knowledge about childbirth among pregnant women participating in the Senses of Birth Intervention in Brazil: A cross-sectional study

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