BackgroundCaesarean section rates in Brazil have been steadily increasing. In 2009, for the first time, the number of children born by this type of procedure was greater than the number of vaginal births. Caesarean section is associated with a series of adverse effects on the women and newborn, and recent evidence suggests that the increasing rates of prematurity and low birth weight in Brazil are associated to the increasing rates of Caesarean section and labour induction.MethodsNationwide hospital-based cohort study of postnatal women and their offspring with follow-up at 45 to 60 days after birth. The sample was stratified by geographic macro-region, type of the municipality and by type of hospital governance. The number of postnatal women sampled was 23,940, distributed in 191 municipalities throughout Brazil. Two electronic questionnaires were applied to the postnatal women, one baseline face-to-face and one follow-up telephone interview. Two other questionnaires were filled with information on patients’ medical records and to assess hospital facilities. The primary outcome was the percentage of Caesarean sections (total, elective and according to Robson’s groups). Secondary outcomes were: post-partum pain; breastfeeding initiation; severe/near miss maternal morbidity; reasons for maternal mortality; prematurity; low birth weight; use of oxygen use after birth and mechanical ventilation; admission to neonatal ICU; stillbirths; neonatal mortality; readmission in hospital; use of surfactant; asphyxia; severe/near miss neonatal morbidity. The association between variables were investigated using bivariate, stratified and multivariate model analyses. Statistical tests were applied according to data distribution and homogeneity of variances of groups to be compared. All analyses were taken into consideration for the complex sample design.DiscussionThis study, for the first time, depicts a national panorama of labour and birth outcomes in Brazil. Regardless of the socioeconomic level, demand for Caesarean section appears to be based on the belief that the quality of obstetric care is closely associated to the technology used in labour and birth. Within this context, it was justified to conduct a nationwide study to understand the reasons that lead pregnant women to submit to Caesarean sections and to verify any association between this type of birth and it’s consequences on postnatal health.

Social inequalities and women's satisfaction with childbirth care in Brazil: a national hospital-based surveyDesigualdades sociais e satisfação das mulheres com o atendimento ao parto no Brasil: estudo nacional de base hospitalar Diferencias sociales y satisfacción de las mujeres con la atención al parto en Brasil: estudio nacional de base hospitalaria

Explanations for increased cesarean section rates in Brazil have focused on the organization of obstetric care, training of health professionals, and women's demand for

Apesar da ampliação da cobertura da atenção pré-natal e hospitalização do parto, houve estabilização no coeficiente de mortalidade materna em valores relativamente altos, atribuída aqui à qualidade inadequada da atenção. Um dos componentes do processo de assistência é a relação interpessoal, à qual tem sido associado o conceito de humanização. Identifica-se um forte movimento internacional que aborda a humanização da atenção a nascimentos e partos como uma resposta à mecanização na organização do trabalho profissional e à violência institucional, com crescente produção teórica. Todavia, o termo é polissêmico e faz-se necessário, ao deparar-se com a expressão, identificar que perspectiva está sendo adotada e qual o sentido que lhe é conferido.

Objectives: to identify caesarean and vaginal births and their association with temporal and sociodemographic variables.Methods: a mixed approach involving descriptive time series studies (2000, 2005, 2010) and one crosssectional study (2011) (2000, 2005, 2010)