Brazil has extremely high cesarean rates. Among related factors, it has been suggested that a "culture of cesarean childbirth" (or a preference for this type of delivery) exists among Brazilian women. Our study investigates this notion. Data were collected from September 1998 to March 1999 in two maternity hospitals in Rio de Janeiro Interviews were conducted and hospital records analyzed for a random representative sample of 909 women who had just given birth (454 vaginal deliveries and 455 cesareans). In the interviews, when asked if they had wanted to have a cesarean, 75.5% replied in the negative, thus indicating that these women cannot be considered as adhering to a "culture of cesarean sections" The main complaints against cesareans were: slower and more difficult recovery (39.2%) and greater pain and suffering (26.8%). However, 17% of the sample had at some point requested a cesarean, 75% of whom during labor. Analysis revealed that the request for a cesarean section is directly proportional to time between admission to the hospital and delivery. This suggests that (in addition to being the usual means of access to tubal ligation) the actual circumstances of birthing are important factors in Brazilian women s requests for cesarean sections.

This study analyzes the different representations and experiences of women from different social classes, including issues related to their relations with hospital staff in different institutional settings. This qualitative study focused on women who had experienced both types of delivery, in three maternity hospitals in Rio de Janeiro, Brazil (one public, one fully private, and another private under an outsourcing agreement with the public health system). The study showed that variations in public and private service models result in different types of delivery care and different relations with staff, and are reflected in different birthing experiences for the women. However, a critical gender perspective shows that in both cases, the service models reproduce the medicalization of childbirth and women's submission as objects in the birthing process. Although this is manifested in different ways in the three groups, the end result is to reduce the range of care and the possibility of women's empowerment during childbirth.

The Center for Data and Knowledge Integration for Health (CIDACS) was created in 2016 in Salvador (Bahia, Brazil). This paper aims to present a profile of CIDACS, including its current databases. CIDACS aims to conduct interdisciplinary studies and research, develop new scientific methodology and promote professional training using linked large-scale databases and high-performance computational resources in a secure environment. Administrative data is at the core of the activities conducted by CIDACS. The advantages of administrative data include significantly larger sample sizes, an inherent longitudinal structure and high-quality information. The center’s research projects are primarily focused on enhancing the understanding surrounding the impact of social protection policies (e.g., public cash-transfer and housing programs) on health outcomes in low-income populations throughout Brazil. CIDACS’ primary data source is citizens who register with the Cadastro Único program, which encompasses individuals eligible to receive benefits from over 20 governmental social programs. CIDACS has two separate environments for data handling: 1) Data Production Center, a secure room housing the computational infrastructure for ingesting, storing, cleaning, processing and linking original databases, as well as extracting research-ready datasets and 2) Data Analysis Environment, a computational infrastructure based on data safe haven principles, which allows researchers to access and process requested datasets. Brazil has a large public health community that uses national health and social databases for research programs, and the linkage of different databases has been a widely employed practice in the country. CIDACS is the result of efforts by researchers, policymakers and public health officials to use and improve the quality of Brazilian health databases. CIDACS is expected to be an important resource for researchers and policymakers interested in improving the evidence base in different aspects of health, as well as with regard to the social determinants of health and the effects of social and environmental policies on health in general.

Resumo ObjetivoAvaliar a qualidade da atenção durante o processo de trabalho de parto de acordo com normas da Organização Mundial de Saúde. Métodos Trata-se de estudo do tipo caso-controle, realizado em duas maternidades: pública e conveniada com o Sistema Único de Saúde, no Município do Rio de Janeiro. A amostra foi composta por 461 mulheres na maternidade pública (230 partos vaginais e 231 cesáreas) e por 448 mulheres na maternidade conveniada (224 partos vaginais e 224 cesáreas). De outubro de 1998 a março de 1999, foram realizadas entrevistas com puérperas e revisão de prontuários. Foi construído escore sumarizador da qualidade do atendimento. Resultados Observou-se baixa freqüência de algumas práticas que devem ser encorajadas, como presença de acompanhante (1% na maternidade conveniada, em ambos os tipos de parto), deambulação durante o trabalho de parto (9,6% das cesáreas na maternidade pública e 9,9% dos partos vaginais na conveniada) e aleitamento na sala de parto (6,9% das cesáreas na maternidade pública e 8,0% das cesáreas na conveniada). Práticas comprovadamente danosas e que devem ser eliminadas como uso de enema (38,4%), tricotomia, hidratação venosa de rotina (88,8%), uso rotineiro de ocitocina (64,4%), restrição ao leito durante o trabalho de parto (90,1%) e posição de litotomia (98,7%) para parto vaginal apresentaram alta freqüência. Os melhores resultados do escore sumarizador foram obtidos na maternidade pública. Conclusões As duas maternidades apresentam freqüência elevada de intervenções durante a assistência ao parto. A maternidade pública, apesar de atender clientela com maior risco gestacional, apresenta perfil menos intervencionista que maternidade conveniada. Procedimentos realizados de maneira rotineira merecem ser discutidos à luz de evidências de seus benefícios.