Abstract
The aim of this study was to analyze the sociodemographic factors associated with cesarean section in adult women with conditions favorable for normal delivery and to identify the groups most likely to undergo this surgery in the state of Santa Catarina (SC). A case control study with microdata from the Sistema de Informação de Nascidos Vivos on 7,065 women for 2016 in SC. A relationship between cesarean section and sociodemographic variables was analyzed by logistic regression where we calculated the Adjusted Odds Ratio (AOR), confidence interval and p-value. The probability of cesarean section for each group of women (called "interaction") was also calculated. Among women with more favorable conditions for normal childbirth, the prevalence of cesarean section was 41.1%. Lower chance of cesarean section was found for women without partners (AOR: 0.79 [0.71-0.87]), up to 8 years of schooling (AOR: 0.56 [0.47-0.66]), with up to 2 prenatal visits (AOR: 0.46 [0.23-0.90]). The most likely group of women (51.4% [49.3-53.4]) to undergo cesarean section are women who perform 7 to 15 prenatal visits and have 12 or more years of schooling. A cesarean section occurs with women who have greater access to education and prenatal care and those who have partners, even though the aspects favor normal childbirth, suggesting that this does not seem to be a decision only by women.
Highlights
Cesarean surgery emerged as a medical necessity and decreased mortality rates and the occurrence of neonatal and maternal sequelae (Souza et al, 2018)
In order to avoid selection bias, births performed outside the hospital environment, assisted by a non-medical professional and with a number of visits greater than or equal to 16, were excluded, considering that a pregnant woman undergoing a high number of visits may present some condition during pregnancy in which cesarean section is recommended, and this condition is not included in the Declaration of Live Birth, source of data for this study
In 2016, the prevalence of cesarean sections among live births in Santa Catarina was 57.6%, while in the records selected for the present study it was 41.1%, with the ratio of cesarean sections to vaginal childbirths equal to 1: 1.4 and the difference between the two relative frequencies, 16.5%
Summary
Cesarean surgery emerged as a medical necessity and decreased mortality rates and the occurrence of neonatal and maternal sequelae (Souza et al, 2018). The main recommendations for performing cesarean sections are described in the literature, the issues that contribute to high cesarean rates are multifactorial, complex and still remain poorly explained (Panda, Begley, & Daly, 2018). Issues such as social, demographic, cultural and economic factors of pregnant women, related to the care model, aspects of medical work and other professionals can influence the decision for cesarean section, even when there are favorable conditions for vaginal delivery (Patah & Malik, 2011). South America has the highest average cesarean rates in the world (42.9%). The countries with the highest rates of cesarean sections in Latin America and the Caribbean are Brazil (55.6%) and the Dominican Republic (56.4%), Egypt (51.8%) in Africa, Iran and Turkey in Asia (47.9% and 47.5%, respectively), Italy (38.1%) in Europe, the United States (32.8%) in North America and New Zealand (33.4%) in Oceania (Betrán, Zhang, Gülmezoglu, & Torloni, 2016)
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