Strategic measures to reduce the caesarean section rate in Brazil

Occhi, Gilberto Magalhães; Netto, Thereza de Lamare Franco; Neri, Monica; Rodrigues, Euzi Adriana Bonifácio; Fernandes, Ana D.

doi:10.1016/s0140-6736(18)32407-3

Cited by 24 publications

(22 citation statements)

References 5 publications

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“…Other countries considered emerging global economies have high cesarean rates, likely corresponding with improved access to advanced health services in the general population. For example, the estimated national cesarean rates in Brazil and China are 55.4% and 41.3% of births, respectively [29,30].…”

Section: Discussionmentioning

confidence: 99%

Maternal Factors Associated with Mode of Delivery in a Population with a High Cesarean Section Rate

Gondwe¹,

Betha²,

Kusneniwar³

et al. 2019

JEGH

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We sought to identify factors associated with mode of delivery in a peri-urban Indian population with a high cesarean section rate. Poisson regression with robust error variance was applied to model factors associated with cesarean compared to vaginal delivery in a prospective, preconception pregnancy cohort study in Telangana State, India. Adjusted relative risks and 95% confidence intervals from multivariable models are presented. Among 1164 singleton births between 2010 and 2015, 46% were delivered by cesarean. In multiparous women (n = 674), prior cesarean delivery (4.2, 3.2-5.6), prior twin delivery (1.4, 1.1-1.9), diagnosis of hypertension (1.4, 1.0-2.0), or preeclampsia (3.5, 2.1-5.7) in a prior pregnancy independently increased the risk of cesarean. Prepregnancy overweight/obesity (1.4, 1.0-1.9), a composite of prenatal complications (1.3, 1.0-1.7), a composite of labor complications (1.5, 1.0-2.3), nonreassuring fetal heart rate (2.3, 1.3-4.1), and breech position (2.6, 1.4-5.0) also increased the cesarean risk. Among nulliparous women (n = 233), cephalo-pelvic disproportion (1.9, 1.2-3.0), a composite of labor complications (2.9, 1.8-4.9), and breech position (3.4, 1.9-6.2) increased the risk of cesarean. The high rate of cesarean delivery in this peri-urban Indian population is attributed to history of pregnancy complications, history of prior cesarean, prepregnancy body mass index, and medical indications at delivery.

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Section: Discussionmentioning

confidence: 99%

Maternal Factors Associated with Mode of Delivery in a Population with a High Cesarean Section Rate

Gondwe¹,

Betha²,

Kusneniwar³

et al. 2019

JEGH

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“…According to the latest available data in Brazil, 55.4% of all live births in 2018 were by cesarean birth and 10.1% of all deliveries were preterm . National maternal mortality ratios, which were practically stagnant since the turn of the century, increased in recent years reaching 64 deaths per 100 000 live births in 2017 .…”

Section: Introductionmentioning

confidence: 99%

Using the Maternity Safety Thermometer to estimate harm‐free care in Southeast Brazil: A hospital‐based cohort

Salgado

Queiroz

Santos

et al. 2019

Birth

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Background High rates of unnecessary cesareans and interventions in vaginal births contribute to stagnant maternal and neonatal mortality rates in Brazil. We used the Maternity Safety Thermometer (MST) to assess the prevalence of harm during maternity care. Methods This secondary analysis of the “Birth in Brazil” survey included a representative sample of 10 155 women who gave birth in public and private hospitals in southeastern Brazil. The main outcomes were perineal and abdominal trauma, maternal infection and hemorrhage, newborn vitality, and women's perception of safety. We calculated the odds ratios (OR) for the number of MST harms (dependent variable). Results About 81.6% of the women with vaginal births had sutures for perineal trauma (87.7% of these due to episiotomies). Poor perception of safety was reported by 83.1% of women, and 69.5% of all infants not admitted to the NICU were separated from their mother after birth. The overall rate of cesarean birth was 52.6%, and 7.5% of term infants were admitted to the NICU. In public settings, having an intrapartum cesarean significantly increased the chances of one (OR 2.21; 95% CI 1.20‐4.07), or two or more (4.08 [2.27‐7.32]) harms. In private settings, cesarean deliveries without labor were also associated with higher chances of one (4.26 [2.65‐6.85]), or two or more (4.60 [2.35‐9.02]) harms. Only 2% of the women had harm‐free care. Conclusions In southeastern Brazil, there is a high prevalence of preventable harm during maternity care.

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“…Additional reasons for the high cesarean rate in Brazil might be related to the model of care and physicians' beliefs and behavior. Different authors have discussed the increased rates of cesarean in the private sector, creating a paradox of care, in which low-risk women have more interventions (35)(36)(37). Studies show that, frequently, the relationship between women and obstetricians is asymmetrical and physician-centered, with no place for women's choices and preferences (16,37,38).…”

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confidence: 99%

Changes in perceived knowledge about childbirth among pregnant women participating in the Senses of Birth Intervention in Brazil: A cross-sectional study

Fernandes

Lansky

Oliveira

et al. 2019

Preprint

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Background: Senses of Birth (SoB) is a health education intervention in Brazil that addresses reproductive rights, the benefits and risks of normal birth and cesarean, and use of evidence-based practices (EBP) during labor and childbirth, aiming to reduce unnecessary cesareans in the country. This study evaluates the impact of the SoB intervention on pregnant women's perceived knowledge about normal birth, cesarean, and use of EBP in childbirth. Method: 1,287 pregnant women answered a structured questionnaire, immediately after their visit to the exhibition, between March 2015 and March 2016, in four cities. To identify the impact of the intervention on women's perceived knowledge and possible association with socioeconomic and demographic characteristics, statistical analyses were performed including paired T-tests, ANOVA, and logistic and linear regressions. Results: The mean score (MS) of perceived knowledge after the intervention was higher than the mean score before experiencing the SoB for all three knowledge domains: Normal Birth (MS Before= 3.71 x MS After= 4.49), Cesarean (MS Before= 3.54 x MS After= 4.26) and EBPs (MS Before= 3.14 x MS After= 4.14). The results suggest that SoB intervention was more effective for low income women (B = 0.206; p < 0.001 for EBP), women without private health insurance (OR 2.47, 95% CI: 1.49-4.09 for normal birth), women with private prenatal care (OR 2.42, 95% CI: 1.59-3.66 for normal birth), women experiencing their first pregnancy (OR 1.92, 95% CI: 1.31-2.82 for EBP; OR 1.37, 95% CI: 1.03-1.84 for normal birth; OR 1.37, 95% CI: 1.03-1.84 for cesarean), and women in their first or second trimester at the time of the intervention (OR 1.64, 95% CI: 1.13-2.39 for EBP; OR 1.48, 95% CI: 1.11-1.97 for normal birth; OR 1.85, 95% CI: 1.40-2.41 for cesarean). Conclusion: The study showed opportunities to increase knowledge among Brazilian pregnant women for the three knowledge domains, and a need to focus the discussion on how to achieve a positive experience of birth using EBP. The intervention gains relevance considering the lack of evidence of the efficacy of non-clinical interventions to reduce unnecessary cesareans in middle and low-income countries targeting women.

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Strategic measures to reduce the caesarean section rate in Brazil

Cited by 24 publications

References 5 publications

Maternal Factors Associated with Mode of Delivery in a Population with a High Cesarean Section Rate

Maternal Factors Associated with Mode of Delivery in a Population with a High Cesarean Section Rate

Using the Maternity Safety Thermometer to estimate harm‐free care in Southeast Brazil: A hospital‐based cohort

Changes in perceived knowledge about childbirth among pregnant women participating in the Senses of Birth Intervention in Brazil: A cross-sectional study

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