Abstract
Introduction: There has been an increase in the proportion of cesarean deliveries, especially in developing countries. Methods: Cross-sectional study of all hospital live births from mothers living in Sao Paulo Metropolitan Area, Brazil. Data were obtained from the Live Birth Information System, which is linked to the National Database of Health Establishments. Hospitals were classified as public, private or mixed. Descriptive analysis and exponential regression were conducted to evaluate time trends. Poisson regression was applied to analyze each hospital type to identify risk factors and the attributable risk fraction for cesarean section. Results: There was an annual increase (1.4%) of cesarean deliveries between 2000 and2013. In2009, the percentage of cesarean deliveries was 53% overall and 83% in private hospitals. The primary risk factor for cesarean delivery was delivery in a private hospital. Other risk factors that were stronger in public hospitals included the following: advanced maternal age, high maternal education, nulliparity, high number of prenatal visits, multiple pregnancy, hospital with low annual volume of deliveries, birth outside the city of residence and white skin color. Discussion: These results may be explained by the obstetric care model of private hospitals, which is not multiprofessional. Prenatal care and delivery are conducted by the same doctor and rarely include the input of another professional, such as a midwife. In addition, the mode of delivery influences the professional’s payment.
Highlights
There has been an increase in the proportion of cesarean deliveries, especially in developing countries
This study evaluated the temporal tendency of cesarean sections in the metropolitan area of São Paulo and identified risk factors for cesarean births per type of hospital for 2009
The proportion of births by cesarean was of 32% in public hospitals, 44% in mixed hospitals, and 82% in private hospitals
Summary
There has been an increase in the proportion of cesarean deliveries, especially in developing countries. Other risk factors that were stronger in public hospitals included the following: advanced maternal age, high maternal education, nulliparity, high number of prenatal visits, multiple pregnancy, hospital with low annual volume of deliveries, birth outside the city of residence and white skin color. The increase in the proportion of cesarean sections in recent decades is a public health problem, especially in developing countries [1]. A cesarean section is a surgical procedure that increases the risk of maternal and neonatal morbidities [2], and the cost of delivery care [3]. A recent study showed that 27.5% of Brazilian women had an initial preference for cesarean delivery [6] This high cesarean preference was not found in other places in a recent meta-analysis study [7]
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