Factors associated to the type of childbirth in public and private hospitals in Brazil

Guimarães, Raphael Mendonça; Silva, Rafael Leiróz Pereira Duarte; Dutra, Viviane Gomes Parreira; Andrade, Pedro Gomes; Pereira, Ana Camila Ribeiro; Jomar, Rafael Tavares; Freire, Renata Pascoal

doi:10.1590/1806-93042017000300009

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Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 17 (3) • Jul-Sep 2017 • https://doi.org/10.1590/1806-93042017000300009 copy

Factors associated to the type of childbirth in public and private hospitals in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to estimate the prevalence of cesarean sections and factors associated to the type of childbirth in Brazil.

Methods:

data on childbirths were collected in Brazil in 2014. Demographic characteristics, related to pregnancy and birth hospital regime (public or private) were evaluation. For each hypothesis raised, the variables were modeled by the binary logistic regression, which the outcome was considered in the type of childbirth.

Results:

the prevalence of the cesarean sections in Brazil in 2014 was 52.8%; that is 38.1% at public hospitals and 92.8% at private ones. The association between cesarean section and the legal regime at the hospital was highlighted in the logistic model which presented a positive association and interaction between age groups (OR = 23.26; 95% CI= 13.39 - 41.79 for women between 20 and 24 years old and OR = 51.04; 95% CI 31.06 - 84.23 for women aged 35 and over).

Conclusions:

the performance of childbirth in Brazil meets the routines and recommendations regarding women's health and humanized childbirth established by the Brazilian National Health System policies.

Key words
Women's health; Cesarean section; Socioeconomic factors; Health management; Hospital administration

Variables	Childbirth						p
	Vaginal		Cesarean		Total
	n	%	n	%	n	%
Age group (years)
Up to 19	343,969	26.69	159,753	9.45	503,812	16.91
20-24	381,214	29.58	302,262	17.88	683,506	22.94
25-29	265,097	20.57	424,148	25.09	689,173	23.13
30-34	184,936	14.35	468,608	27.72	653,555	21.94
35 or older	113,410	8.80	335,734	19.86	449,215	15.08
Total	1,288,754	100.00	1,690,505	100.00	2,979,259	100.00
Martial Status							<0.001
Without a partner	992,985	77.05	866,384	51.25	1,859,474	62.41
With a partner	295,769	22.95	824,121	48.75	1,119,785	37.59
Total	1,288,754	100.00	1,690,505	100.00	2,979,259	100.00
Schooling							<0.001
Up to 8 years	427,995	33.21	240,897	14.25	668,949	22.45
8 years or more	860,759	66.79	1,449,608	85.75	2,310,310	77.55
Total	1,288,754	100.00	1,690,505	100.00	2,979,259	100.00
Type of pregnancy							<0.001
Single	1,278,444	99.20	1,629,478	96.39	2,908,002	97.61
Multiple	10,310	0.80	61,027	3.61	71,256	2.39
Total	1,288,754	100.00	1,690,505	100.00	2,979,259	100.00
Primiparous							<0.001
Yes	824,674	63.99	979,140	57.92	1,803,747	60.54
No	464,080	36.01	711,364	42.08	1,175,512	39.46
Total	1,288,754	100.00	1,690,505	100.00	2,979,259	100.00
Gestation							<0.001
Premature	1,105,236	85.76	1,417,488	83.85	2,522,813	84.68
Up to term	183,519	14.24	273,017	16.15	456,446	15.32
Total	1,288,754	100.00	1,690,505	100.00	2,979,259	100.00
Prenatal consultations							<0.001
Adequate	548,752	42.58	340,975	20.17	889,670	29.86
Inadequate	740,003	57.42	1,349,530	79.83	2,089,589	70.14
Total	1,288,754	100.00	1,690,505	100.00	2,979,259	100.00
Type of hospital							<0.001
Public	1207,047	93.66	699,531	41.38	1,906,538	63.99
Private	81,707	6.34	990,974	58.62	1,072,721	36.01
Total	1,288,754	100.00	1,690,505	100.00	2,979,259	100.00
Place of residence							<0.001
The same as the childbirth place	1,183,334	91.82	1,479,361	87.51	2,662,705	89.37
Different than the childbirth place	105,420	8.18	211,144	12.49	316,554	10.63
Total	1,288,754	100.00	1,690,505	100.00	2,979,259	100.00

Variables	Levels	β	Standard error	CI95%		Wald Test (Z)	p	gl
Variables	Levels	β	Standard error	Min	Max	Wald Test (Z)	p	gl
(Intercept)		-1.171	0.039	-1.248	-1.094	892,336	< 0.001	1
Hospital^a a The reference range is Public hospital";	Private hospital	2.846	0.192	2.485	3.240	219,840	< 0.001	1
Age^b b The reference range is "up to 19 years of age";	20 to 24 years old	0.085	0.012	0.062	0.107	10,008	0.002	1
	25 to 29 years old	0.272	0.054	0.166	0.378	25,.70	< 0.001	1
	30 a to 34 years old	0.394	0.055	0.285	0.502	50,481	< 0.001	1
	35 years oldor more	0.570	0.058	0.457	0.683	98,089	< 0.001	1
Type of pregnancy^c c The reference range is "only one";	Multiple	1.554	0.070	1.419	1.693	494,306	< 0.001	1
Martial Status^d d The reference range is "no partner";	With partner	0.059	0.020	0.019	0.099	8,480	0.004	1
Schooling^e e The reference range is "Low - up to 8 schooling years";	High level	0.090	0.039	0.013	0.167	9,268	0.001	1
Prenatal consultations^f f The reference range is "Less than 7 consultations";	7 or more	0.292	0.019	0.256	0.329	246,741	< 0.001	1
Place of residence^g g The reference range is "the same as the childbirth location";	Another city	0.524	0.028	0.469	0.578	356,417	< 0.001	1
Number of childbirths^h h The reference range is "Multiparous";	Primiparous	0.186	0.041	0.106	0.267	11,871	< 0.001	1
Type of gestationⁱ i The reference range is "at term gestation (37 to 41 weeks)".	Preterm and Post-term	0.253	0.024	0.207	0.300	113,124	< 0.001	1
Interaction term 1	Private*20 to 24 years old	0.083	0.021	0.041	0.125	7,152	< 0.001	1
(hospital*age group)	Private *25 to 29 years old	0.146	0.020	0.106	0.186	10,006	< 0.001	1
	Private *30 to 34 years old	0.238	0.020	0.199	0.278	101,409	< 0.001	1
	Private *35 years old or older	0.520	0.023	0.475	0.565	355,574	< 0.001	1
	High level*20 to 24 years old	0.169	0.056	0.059	0.279	9,006	0.003	1
Interaction term 2	High level*25 to 29 years old	0.218	0.059	0.102	0.335	13,550	<0.001	1
(schooling*age group)	High level 30 a 34 anos	0.310	0.062	0.188	0.432	24,850	<0.001	1
	High level 35 years old or older	0.477	0.067	0.345	0.609	50,240	<0.001	1
	Primiparous*20 a 24 anos	0.181	0.055	0.074	0.289	10,923	0.001	1
	Primiparous	0.379	0.061	0.259	0.498	38,452	< 0.001	1
Interaction term 3	Primiparous*30 to 34 years old	0.368	0.077	0.217	0.520	22,743	< 0.001	1
(number of childbirths*age group)	Primiparous*35 years old or older	0.459	0.105	0.254	0.667	19,010	< 0.001	1
Interaction term 4	Private*Primiparous	0.175	0.056	0.065	0.285	10,601	0.004	1
(hospital * number of childbirths)								1

Age group	π₁	π₀	π₁ Ratio	π₀ Ratio	Odds Ratio	CI95%
20 to 24 years old	0.89	0.25	7.85	0.34	23.26	13.39	33.13
25 to 29 years old	0.93	0.29	13.04	0.41	32.03	19.27	44.79
30 to 34 years old	0.95	0.37	17.03	0.46	37.03	23.1	50.96
35 years old or older	0.97	0.45	27.98	0.55	51.04	31.96	70.12

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[TFN1] ^a
The reference range is Public hospital";

[TFN2] ^b
The reference range is "up to 19 years of age";

[TFN3] ^c
The reference range is "only one";

[TFN4] ^d
The reference range is "no partner";

[TFN5] ^e
The reference range is "Low - up to 8 schooling years";

[TFN6] ^f
The reference range is "Less than 7 consultations";

[TFN7] ^g
The reference range is "the same as the childbirth location";

[TFN8] ^h
The reference range is "Multiparous";

[TFN9] ⁱ
The reference range is "at term gestation (37 to 41 weeks)".