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. 2011 Aug;45(4):635-43.
doi: 10.1590/s0034-89102011005000039. Epub 2011 Jun 10.

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

Aluísio J D Barros  1 , Iná S Santos, Alicia Matijasevich, Marlos Rodrigues Domingues, Mariângela Silveira, Fernando C Barros, Cesar G Victora
Affiliations

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

Aluísio J D Barros et al. Rev Saude Publica. 2011 Aug.

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.

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Figures

Figure 1
Figure 1
C-section prevalence by maternal schooling and source of payment for birth (public or private). Pelotas, Southern Brazil, 2004.
Figure 2
Figure 2
Number of vaginal and C-section deliveries by weekday. Lines indicate the 95% distribution limits based on Poisson distribution. Pelotas, Southern Brazil, 2004.
Figure 3
Figure 3
Number of C-section births per hour occurring from Monday to Friday by source of payment for birth. Pelotas, Southern Brazil, 2004.
See this image and copyright information in PMC

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