TITLE:
Proportion of Cesarean Deliveries According to Hospital Funding in São Paulo Metropolitan Area, Brazil
AUTHORS:
Priscila Ribeiro Raspantini, Zilda Pereira da Silva, Gizelton Pereira Alencar, Bárbara Laisa Alves Moura, Felipe Parra do Nascimento, Laura Cunha Rodrigues, Patrícia Carla dos Santos, Marcia Furquim de Almeida
KEYWORDS:
Cesarean Sections, Risk Factors, Public, Private and Mixed Hospitals, Poisson Regression
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.5 No.14,
November
30,
2015
ABSTRACT: Introduction: There has been an increase in the proportion of cesarean
deliveries, especially in developing countries. Methods: Cross-sectional study
of all hospital live births from mothers living in Sao Paulo Metropolitan Area,
Brazil. Data were obtained from the Live Birth Information System, which is
linked to the National Database of Health Establishments. Hospitals were
classified as public, private or mixed. Descriptive analysis and exponential
regression were conducted to evaluate time trends. Poisson regression was
applied to analyze each hospital type to identify risk factors and the
attributable risk fraction for cesarean section. Results: There was an annual increase
(1.4%) of cesarean deliveries between 2000 and2013. In2009, the
percentage of cesarean deliveries was 53% overall and 83% in private hospitals.
The primary risk factor for cesarean delivery was delivery in a private
hospital. Other risk factors that were stronger in public hospitals included
the following: advanced maternal age, high maternal education, nulliparity,
high number of prenatal visits, multiple pregnancy, hospital with low annual
volume of deliveries, birth outside the city of residence and white skin color.
Discussion: These results may be explained by the obstetric care model of
private hospitals, which is not multiprofessional. Prenatal care and delivery
are conducted by the same doctor and rarely include the input of another
professional, such as a midwife. In addition, the mode of delivery influences
the professional’s payment.