Abstract
BackgroundTo evaluate the prevalence and factors associated with cesarean delivery according to whether care was provided in public or private hospitals in Brazil.MethodsThis was a cross-sectional study based on a cohort of live births between April 2004 and March 2005. A total of 1,344 mother-child pairs were followed up during the first month of life. The variables analyzed were the socioeconomic and demographic characteristics of the mother and newborn, as well as the healthcare provided during pregnancy and childbirth. Hierarchical analysis was carried out for both prediction models, i.e. healthcare provision either within the Brazilian National Health System (public service) or within the private network. Prevalence and association measurement calculations were carried out. Values were considered significant when pless than or equal to 5.0 %.ResultsA total of 1,019 (75,8 %) gave birth in public hospital. The prevalences of cesarean delivery were 29.9 % and 86.2 % in the public and private sectors, respectively. Through hierarchical logistic regression, the risk factors for cesarean delivery presented in the public hospital were maternal age greater than or equal to 20 years (p = 0.003), primiparity (p = 0.004), twinning (p = 0.039), prenatal care provided in the private network (p = 0.004), delivery in hospitals providing high complexity medical care (p = 0.000) and prenatal care with greater than or equal to 6 consultations (p = 0.035). In the private sector, no association was observed between the variables studied and cesarean delivery.ConclusionsThe cesarean delivery rates were high in both sectors, although in the private network the rate was almost triple that of the public service. The absence of determinant factors of birth in the private sector drew attention. In planning measures against the growing cesarean rates, it is necessary to take into consideration the environmental determinants as primiparity, twinning and greater maternal age, frequent indications of primary cesarean delivery, as well as to implement actions that might improve the quality of prenatal and delivery care.
Highlights
To evaluate the prevalence and factors associated with cesarean delivery according to whether care was provided in public or private hospitals in Brazil
The present study aimed to identify the prevalence of cesarean delivery and the associated factors, according to whether births took place in public or private hospitals, in the municipality of Feira de Santana, Bahia, Brazil
Study population and prevalence of deliveries A total of 1,344 women were assessed, of whom 75.8 % (1019) gave birth in establishments connected to Brazilian National Health System (BNHS)
Summary
Normal/vaginal delivery respects the woman’s physiological processes and is associated with lower morbidity and mortality rates for the mother-child pair [1]. Despite the advantages of vaginal birth, there has been a progressive increase in cesarean delivery as a worldwide phenomenon since the 1960s. Previous studies have observed two major tendencies in the distribution of surgical delivery in developing countries. Poorer countries (especially African countries) have lower rates, due to limited access to the procedure, Vieira et al BMC Pregnancy and Childbirth (2015) 15:132 even when indicated, with a consequent impact on morbidity-mortality among mothers and newborns. On the other hand, developing countries with a more stable economic situation, such as Latin American countries and China, have high rates [4]
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