Abstract
The objective of this study was to compare the effects of the modes of delivery on the health of newborns in a private maternity hospital in the city of São Paulo. Between January 1995 and December 1998, all patients consecutively admitted for deliveries were included in this cross-sectional retrospective study. A total of 8,457 medical records were analyzed, being excluded of the sample 460 multiple pregnancies and 517 pregnant women with obstetric and/or clinical disorders. The incidence of neonatal birth injury, respiratory distress and anoxia was analyzed, as well as birth weight, type of delivery and gestational age (according to Näegele and Capurro). The final sample consisted of 7,480 neonates, and 69.6% were born by cesarean section, 24% vaginally and 6.4% through the vagina with the aid of forceps. A significant association was found between anoxia and the three types of delivery (p < 0.001). Respiratory distress was more frequent in cesarean delivery in newborns with gestational age superior to 37 weeks and in newborns weighing more than or equal to 2,500 g. Respiratory distress was significantly associated with cesarean delivery and/or forceps delivery, as compared with vaginal delivery, in the entire sample. Neonatal birth injury was associated with the use of forceps. In neonates born by cesarean section, anoxia was associated with lower gestational age estimated by the Capurro method and with lower weight. The abdominal approach is associated with greater morbidity of fetuses due to respiratory distress. Vaginal delivery is safer in newborns with more than 37 weeks of gestation and in those weighing more than 2,500 g.
Highlights
Despite the recommendations in the literature, Brazil has not accomplished the ideal rate set by the World Health Organization (WHO) for cesarean delivery[1]
When compared two by two, there was no difference between vaginal and cesarean deliveries regarding the occurrence of anoxia, but there was a significant association with forceps delivery, when compared with both normal (χ2 = 31.72; p < 0.001) and Cesarean deliveries (χ2 = 50.10; p < 0.001) (Table1)
A total of 394 (5.3% of total deliveries) neonates were less than 37 weeks of gestational age and anoxia occurred in 39 NB of this group, corresponding to 10% of the preterm children
Summary
Despite the recommendations in the literature, Brazil has not accomplished the ideal rate set by the World Health Organization (WHO) for cesarean delivery[1]. Some authors stated that the acceptable rate of cesarean deliveries for tertiary-care maternity should be between 10 and 12% for single gestations, with the exception of an interventionist attitude in the case of very low birth weight newborns[3]. The incidence of cesarean deliveries in Brazilian hospitals is high and it is intriguing that this value is higher at private institutions. A 72% rate of cesarean deliveries was found in private hospitals and 31% in public hospitals studied in Brazil[2]. According to DATASUS, the proportion of cesarean sections paid by the SUS (Brazilian public health system) in 2003 was 26.39% of deliveries. The average proportion of cesarean deliveries in private institutions was 81.69%, according to data sent to the SIP (Information System of ANS Products – Ministry of Health) by health insurance plans[2]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
