Factors associated with caesarean section among primiparous
          adolescents in Brazil, 2011-2012

Gama, Silvana Granado Nogueira da; Viellas, Elaine Fernandes; Schilithz, Arthur Orlando Corrêa; Filha, Mariza Miranda Theme; Carvalho, Márcia Lazaro de; Gomes, Keila Rejane Oliveira; Costa, Maria Conceição Oliveira; Leal, Maria do Carmo

doi:10.1590/0102-311X00145513

person Silvana Granado Nogueira da Gama

schoolEscola Nacional de Saúde Pública Sergio Arouca,Fundação Oswaldo Cruz,Rio de Janeiro, Brasil.

person Elaine Fernandes Viellas

schoolEscola Nacional de Saúde Pública Sergio Arouca,Fundação Oswaldo Cruz,Rio de Janeiro, Brasil.

person Arthur Orlando Corrêa Schilithz

schoolEscola Nacional de Saúde Pública Sergio Arouca,Fundação Oswaldo Cruz,Rio de Janeiro, Brasil.

person Mariza Miranda Theme Filha

schoolEscola Nacional de Saúde Pública Sergio Arouca,Fundação Oswaldo Cruz,Rio de Janeiro, Brasil.

person Márcia Lazaro de Carvalho

schoolEscola Nacional de Saúde Pública Sergio Arouca,Fundação Oswaldo Cruz,Rio de Janeiro, Brasil.

person Keila Rejane Oliveira Gomes

schoolPrograma de Pós-graduação em Ciências e Saúde, Universidade Federal do Piauí, Teresina, Brasil.

person Maria Conceição Oliveira Costa

schoolPrograma de Pós-graduação em Saúde Coletiva, Universidade Estadual de Feira de Santana, Feira de Santana, Brasil.

person Maria do Carmo Leal

schoolEscola Nacional de Saúde Pública Sergio Arouca,Fundação Oswaldo Cruz,Rio de Janeiro, Brasil.

CorrespondenceS. G. N. Gama. Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. Rua Leopoldo Bulhões 1.480, 8º andar, Rio de Janeiro, RJ 21041-210, Brasil.
emailgranado@ensp.fiocruz.br

Contributors

S. G. N. Gama participated in study conception and in all stages of the production of this article and was responsible for drafting the article and final approval of the version to be published. E. F. Viellas participated in the critical revision of relevant intellectual content, data interpretation and drafting the article and final approval of the version to be published. A. O. C. Schilithz participated in data analysis and interpretation, and drafting the methodology and final approval of the version to be published. M. M. Theme Filha and M. L. Carvalho participated in data analysis and final approval of the version to be published. K. R. O. Gomes and M. C. O. Costa participated in the critical revision of relevant intellectual content, in drafting the introduction and in the final approval of the version to be published. M. C. Leal participated in the final approval of the version to be published.

	Mode of delivery		ρ-value **
	Vaginal (61.5%)	Caesarean (38.5%)	ρ-value **
Adequate level of educational for age			0.061
Yes	56.3	40.7	0.061
No	63.8	36.2
Economic status			< 0.001
Class D+E	68.3	31.7
Class C	59.3	40.7
Class A+B	52.0	48.0
Paid employment			< 0.001
Yes	50.7	49.3	< 0.001
No	62.9	37.1
Skin colour/race			0.022
White	56.6	43.4	0.022
Black	68.4	31.6
Brown	62.7	37.3
Marital status			0.515
No partner	61.7	38.3	0.515
With partner	61.4	38.6
Mother’s age (years)			0.011
10-16	65.0	35.0	0.011
17-19	59.6	40.4

	Mode of delivery		p-value **
	Vaginal (61.5%)	Caesarean (38.5%)	p-value **
Initial preference for mode of delivery			0.007
Vaginal	63.4	36.6
Caesarean	54.0	46.0
No preference	58.8	41.2
Previous pregnancy			0.438
Yes	61.7	38.3
No	59.0	41.0
Previous information about safety of mode of delivery			< 0.001
Normal birth is safer for the mother	70.9	29.1
Caesarean section is safer for the mother	23.4	76.6
Both normal birth and caesarean sections are safe for the mother	41.2	58.8
Unclear	55.5	44.5
Adequacy of prenatal care			0.012
Adequate/more than adequate	58.9	41.1
Inadequate/partially adequate	64.9	35.1

	Mode of delivery		ρ-value **
	Vaginal (61.5%)	Caesarean (38.5%)	ρ-value **
Satisfied at the beginning of pregnancy			0.292
Yes	60.8	39.2
No	63	37
Private childbirth			< 0.001
Yes	23.3	76.7
No	63.8	36.2
Same health professional provides prenatal care and childbirth			< 0.001
Yes	24.5	75.5
No	64.7	35.3
Companion present during hospital admission			0.002
Yes	59.5	40.5
No	68.4	31.6
Clinical history and risk of complications in the current pregnancy			< 0.001
Yes	18.3	81.7
No	64.9	35.1

Variable/Category	OR adjusted	95%CI
Distal model
Adequate level of education for age
Yes	1.1	0.9-1.3
No	1.0	-
Economic status **
Class A+B	1.7	1.3-2.3
Class C	1.4	1.1-1.7
Class D+E	1.0	-
Paid employment
Yes	1.5	1.1-1.9
No	1.0	-
Skin color/race
White	1.2	0.9-1.5
Black	0.8	0.5-1.2
Brown	1.0	-
Mother’s age (years) **
17-19 vs. 10-16	1.2	1.0-1.4
10-16	1.0	-
Intermediary model ***
Initial preference for the mode of delivery
Caesarean	1.1	0.8-1.4
No preference	1.0	0.7-1.4
Vaginal	1.0	-
Prior information on safety of mode of delivery
Caesarean is safer	7.7	4.8-12.3
Both are as safe as the other	3.7	2.7-5.0
Unclear	2.0	1.5-2.7
Normal birth is safer	1.0	-
Adequacy of prenatal care
Adequate or more than adequate	1.2	0.9-1.4
Inadequate or partially adequate	1.0	-
Companion during hospitalization **
Yes	1.4	1.1-1.8
No	1.0	-
Proximal model #
Clinical history and risk of complications in the current pregnancy
Yes	10.8	8.5-13.7
No	1.0	-
Source of payment for childbirth care
Private	4.3	2.1-9.0
Public (SUS)	1.0	-
Same health professional during prenatal care and childbirth
Yes	5.7	3.6-9.0
No	1.0	-

[tfn01t01_en] * Values are weighted according to sample design;

** Significance level based on Pearson’s chi-square test.

Note: vaginal (n = 218,659); caesarean (n = 136,887).

Factors associated with caesarean section among primiparous adolescents in Brazil, 2011-2012

Abstracts