Use of Robson classification to assess cesarean section rate in Brazil: the role of source of payment for childbirth

Abstract

BackgroundCesarean section (CS) rates are increasing worldwide but there is some concern with this trend because of potential maternal and perinatal risks. The Robson classification is the standard method to monitor and compare CS rates. Our objective was to analyze CS rates in Brazil according to source of payment for childbirth (public or private) using the Robson classification.MethodsData are from the 2011–2012 “Birth in Brazil” study, which used a national hospital-based sample of 23,940 women. We categorized all women into Robson groups and reported the relative size of each Robson group, the CS rate in each group and the absolute and relative contributions made by each to the overall CS rate. Differences were analyzed through chi-square and Z-test with a significance level of < 0.05.ResultsThe overall CS rate in Brazil was 51.9 % (42.9 % in the public and 87.9 % in the private health sector). The Robson groups with the highest impact on Brazil’s CS rate in both public and private sectors were group 2 (nulliparous, term, cephalic with induced or cesarean delivery before labor), group 5 (multiparous, term, cephalic presentation and previous cesarean section) and group 10 (cephalic preterm pregnancies), which accounted for more than 70 % of CS carried out in the country. High-risk women had significantly greater CS rates compared with low-risk women in almost all Robson groups in the public sector only.ConclusionsPublic policies should be directed at reducing CS in nulliparous women, particularly by reducing the number of elective CS in these women, and encouraging vaginal birth after cesarean to reduce repeat CS in multiparous women.Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-016-0228-7) contains supplementary material, which is available to authorized users.

Equity of access to maternal health interventions in Brazil and Colombia: a retrospective study

“…Several studies have provided evidence for the reasons behind this high rate of C-section, particularly in Brazil. Some of the reasons include the existence of private health insurance, especially for the wealthier people; lack of information regarding the necessity of the intervention; and cultural reasons [36–39]. Our analysis suggests that twice as many women with private health insurance in Brazil opt for C-section, compared to those without private health insurance.…”

“…Specifically, mean coverage rates of C-section both in Brazil and Colombia are significantly above the upper limit of 15% recommended by the WHO, suggesting that both countries face difficulties in avoiding unnecessary procedures (such as C-section), which sometimes might lead to worse maternal and newborn health outcomes [31, 33–36]. Several studies have provided evidence for the reasons behind this high rate of C-section, particularly in Brazil.…”

A cor da dor: iniquidades raciais na atenção pré-natal e ao parto no Brasil

“…In Brazil, there is an excess number of births at gestational ages of 37 and 38 weeks, which is mainly due to scheduled cesarean births 31 . However, black and brown-skinned women differ from white-skinned women in that they present higher post-term birth prevalence, probably a reflection of "less care" due to fewer interventions than necessary, which may have been required for children born post-term.…”

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

“…The WHO recommends educational intervention and supporting programs for the reduction of cesarean delivery . In Brazil, the rate of delivery by cesarean is very high (>80% in some settings) and extremely variable in different regions . These disparities suggest that the economic, social, and educational structure of the community where a woman lives can influence behaviors, attitudes, values, opportunities, and consequently the option for cesarean delivery.…”