Birth in Brazil: national survey into labour and birth

Abstract

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.

Prevalência de nascimentos pré-termo por peso ao nascer: revisão sistemática

“…In this year, the estimate of 7.1% reported by the SINASC was 385 lower than the corrected prevalence of 11.7%. Preliminary results of the Nascer no Brasil study, 14 based on ultrasounds, indicate that national prevalence of 11.4%, close to the estimate presented here.…”

“…This review included unpublished data regarding the Nascer no Brasil study, 14 which is a multi-centric hospital based cohort that included a post-natal visit and a telephone interview between 45 and 60 days postpartum. The sample was stratified by geographical macro-region, type of municipality and type of hospital.…”

“…the nationwide Nascer no Brasil study, 14 the studies were carried out in the Southeast, South and Northeast. Different methods can be used for assessing gestational age in epidemiological studies.…”

“…Four of them concerned original, unpublished studies: BRISA -cohorts in Ribeirao Preto, SP, and Sao Luís, MA, both from 2010; Rio de Janeiro, RJ, 2010; Pelotas, RS, Intergrowth 2010, 25 and the fifth was a collaborative nationwide study. 14 At the end of the search, twelve databases were available for the research.…”

Why do women in the private sector have shorter pregnancies in Brazil? Left shift of gestational age, caesarean section and inversion of the expected disparity

“…Further details on the sampling process, data collection or other information about NNB are available in Leal et al 14 , Vasconcellos et al 15 and Pereira et al 13 . Ethical aproval for the NNB Survey was granted by the Fiocruz Ethical Committee and all women who agreed in taking part of the survey signed an informed consent.…”