Trends and consequences of the technocratic paradigm of childbirth in Portugal: A population-based analysis of birth conditions and social characteristics of parents

Abstract

Limiting the study of childbirth to its medical aspects leaves important dimensions out of the analysis: women's perception of birth-related risks associated with the medicalised offer of maternity care, and the implications of this childbirth paradigm for health outcomes and for future care.

Spatial Access Matters: An Analysis of Policy Change and Its Effects on Avoidable Infant Mortality in Portugal

“…Furthermore, due to legislation home births are only available in Portugal through private healthcare [39], which widens economic inequality of access to a woman's chosen care during birth. One study found that home births, as well as more "alternative" forms of care, were more common among women of a higher social class, with a higher level of education and more resources [23]. Until 1961, 80% of births in Portugal were home births, a trend which continued into the 1970s.…”

“…The lack of home birth as an option for public healthcare users is one factor in the highly medicalized state of pregnancy and birth in Portugal, and the movement towards this medicalized state has been well documented [35,39]. In 2010 and 2011, 99% of births in Portugal took place in a hospital [23]. The presence of doctors at birth has been increasing while the presence of obstetric and non-obstetric nurses has been decreasing.…”

“…There is a trend for scheduling births on weekdays, with rates of instrumental deliveries and caesarean sections increasing until recently and remaining high [20]: episiotomy rates for vaginal birth were 72.9% in 2013 [42]. This movement is even more evident in the private sector: the rate of caesarean sections more than twice as high in private hospitals as public ones [23]. The greater number of private hospitals in the North region (as shown in Figure 2) correlates with the highest rate of caesarean sections occurring in the North: 36% in 2018 (the lowest was the Central region with 27%) [26].…”

“…Thematic analysis of the interview and survey responses in relation to the impact of the 2006 maternity unit closures on access to care and avoidable infant mortality revealed 4 main themes: impact of maternity unit closures; spatial access matters; current functioning of the healthcare system; and the medicalization of birth. The term "medicalization" was not used in any survey or interview questions but is used in this study to describe the view of birth as a pathological rather than a physiological process, and the subsequent increase in rates of medical intervention in the process, as outlined by Pintassilgo and Carvalho [23].…”

The value of descriptive time series analysis: The case of Portugal

“…However, higher income women tend to deliver in private (rather than public) hospitals. It remains unclear whether physicians in public hospitals would entertain the request by immigrant mothers (such as Brazilian‐born women) to have a caesarean delivery . In addition, explanations for the upward shift in maternal educational attainment, especially after the global economic crisis, would benefit from understanding educational policies as well as the financial cost of university education in Portugal.…”