Cesarean section on demand: a population-based study in Southern Brazil

all births that occurred in the two maternities between 01/01 to 12/31/2007, mothers who lived in the municipality were questioned on demographic and maternal reproductive characteristics, family socioeconomic level and health care received during pregnancy and childbirth. The outcome was constituted by cesarean section on demand, in other words, the request was from the parturient. In the analysis, Poisson regression was used with robust adjustment of the variance. The effect measurement used was the prevalence ratios (PR).

Results:

among the 2,557 parturients included in this study, 51.6% (CI95%:49.6%-53.5%) were submitted to cesarean sections, and 10.7% (CI95%:9.0%-12.4%) were on demand. After the adjustment based on previous hierarchical model, the variables showed significantly the association to the outcomes which were maternal schooling, household income, type of hospitalization (public or private) and being attended by the same physician throughout the prenatal period.

Conclusions:

the PR obtained show that the probability of occurrence of cesarean section on demand was substantially higher among the mothers who presented the lowest risk of complications during pregnancy and childbirth.

Key words:
Women's health; Prenatal care; Childbirth; Cesarean section

Characteristics	Cesarean section on demand				Total		p
	Yes		No		Total
	n	%	n	%	n	%
Maternal age (years)							0.105
15-19	152	11.5	212	16.1	206	15.6
20-29	769	58.3	702	53.2	708	53.7
≥ 30	398	30.2	398	30.7	405	30.7
Skin color							0.025
White	1111	84.2	971	73.6	981	74.7
Mixed	133	10.1	214	16.2	204	15.5
Black	77	5.8	135	10.2	128	9.7
Living with a partner	1186	89.9	1141	86.5	1146	86.9	0.257
Maternal schooling (years)							<0.001
0-8	208	15.8	522	39.6	488	37.0
9 -11	769	58.3	620	47.0	636	48.2
≥ 12	342	25.9	177	13.4	195	14.8
Household income (minimum wage)							>0.001
Up to 1.9	170	12.9	522	39.6	485	36.8
2.0-3.9	427	32.4	488	37.0	481	36.5
≥ 4.0	721	54.7	309	23.4	352	26.7
Type of prenatal care performed							<0.001
Public	303	23.0	922	69.9	855	64.8
Private	1016	77.0	397	30.1	464	35.2
Performed six or more consultations throughout the prenatal care period	1281	97.1	1062	80.5	1086	82.3	<0.001
Mothers who were attended by the same physician throughout the prenatal care period	1262	95.7	993	75.3	1022	77.5	<0.001
Parity							0.005
1	645	48.9	549	41.6	559	42.4
2	522	39.6	459	34.8	466	35.3
≥ 3	152	11.5	311	23.6	294	22.3
Birth weight (grams)							0.012
< 2,500	18	1.4	113	8.6	103	7.8
2,500-2,999	294	22.3	276	20.9	277	21.0
3,000-3,499	645	48.9	530	40.2	542	41.1
≥ 3,500	360	27.3	400	30.3	397	30.1
Referred in doing treatment for hypertension, diabetes and/or depression during prenatal care	218	16.5	364	27.6	348	26.4	0.005

Level	Characteristics	Prevalence of cesarean section on demand		Crude analysis	Adjusted analysis
Level	Characteristics	n	%	PR (CI95%)	PR (CI95%)
I	Maternal age (years)			p=0.11	p=0.60
	15-19	348	7.9	1.00	1.00
	20-24	121	9.2	1.16 (0.65 -2.08)	0.80 (0.46-1.41)
	25-29	182	13.8	1.75 (1.02 -2.98)	0.98 (0.57-1.67)
	≥ 30	140	10.6	1.34 (0.77 -2.32)	0.67 (0.38-1.15)
	Skin color			p=0.01	p=0.09
	White	161	12.1	1.80 (1.16 -2.79)	1.46 (0.95-2.26)
	Mixed/Black	88	6.7	1.00	1.00
	Lives with a partner			p=0.27	p=0.63
	No	108	8.2	1.00	1.00
	Yes	146	11.1	1.35 (0.80 -2.29)	1.14 (0.67-1.92)
	Maternal schooling (years)			p<0.001	p=0.02
	0 to 8	61	4.6	1.00	1.00
	9 to 11	171	13.0	2.83 (1.79 -4.46)	1.92 (1.21-3.05)
	≥ 12	249	18.9	4.10 (2.48 -6.79)	1.70 (0.99-2.92)
	Household income (minimum wage)			p<0.001	p<0.001
	Up to 1.9	50	3.8	1.00	1.00
	2.0 to 3.9	125	9.5	2.52 (1.48 -4.29)	2.06 (1.19 -3.54)
	≥ 4.0	290	22.0	5.81 (3.54 -9.53)	4.39 2.58 -7.45)
II	Type of prenatal care			p<0.001	p=0.18
	Public	42	3.2	1.00	1.00
	Private	239	18.1	5.61 (3.54 -8.89)	1.57 (0.81-3.05)
	Number of prenatal care consulation visits			p<0.001	p=0.30
	< 9	102	7.7	1.00	1.00
	≥ 9	186	14.1	1.83 (1.32 -2.53)	0.84 (0.59-1.17)
	Type of hospitalization			p<0.001	p<0.001
	Public (SUS)	50	3.8	1.00	1.00
	Affiliated	278	21.1	8.05 (5.20 -12.5)	2.84 (1.63 -4.97)
	Private	405	30.7	5.54 (3.72 -8.23)	3.88 (2.17 -6.92)
	The same physician during prenatal care			p<0.001	p=0.01
	No	28	2.1	1.00	1.00
	Yes	177	13.4	6.44 (2.87 -14.4)	2.93 (1.28 -6.72)
III	Parity			p=0.01	p=0.65
	None	164	12.4	2.23 (1.32 -3.77)	1.22 (0.72 -2.09)
	One to two	158	12.0	2.17 (1.27 -3.71)	1.29 (0.76 -2.20)
	Three or more	74	5.6	1.00	1.00
	Birth weight (grams)			p=0.13	p=0.53
	Up to 2,999	117	8.9	1.00	1.00
	3,000 to 3,499	169	12.8	1.45 (0.97 -2.14)	1.23 (0.85 -1.79)
	≥ 3,500	129	9.8	1.11 (0.71 -1.73)	1.22 (0.80-1.87)
IV	Morbidity during pregnancy			p=0.01	p=0.05
	No	161	12.2	1.00	1.00
	Yes	88	6.7	0.55 (0.36 -0.85)	0.65 (0.43-1.00)

Instituto de Medicina Integral Prof. Fernando Figueira Rua dos Coelhos, 300. Boa Vista, 50070-550 Recife PE Brasil, Tel./Fax: +55 81 2122-4141 - Recife - PR - Brazil
E-mail: revista@imip.org.br

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