title: Support from a prenatal instructor during childbirth is associated with reduced rates of caesarean section in a Mexican study.
abstract: OBJECTIVE
  to assess the association between non-clinical factors and the incidence of caesarean section (CS); to estimate the effect of a prenatal instructor's presence during childbirth on birth outcome (vaginal or CS).
  
  
  METHODS
  cross-sectional study from a register of women who attended prenatal classes. Multivariate logistic regression was used to measure the effects of each variable on whether the birth was vaginal or CS.
  
  
  METHODS
  Mexico City, Mexico.
  
  
  METHODS
  992 births to 847 women from the register of the Birth Education Centre (CEPAPAR) between 1987 and 2000.
  
  
  RESULTS
  the incidence of CS was 33%. The most commonly reported (by the women) reason for performing a CS was dystocia (53%). Most women were middle or upper-middle class professionals, and 85% of the women gave birth in private institutions. Odds of having a CS were higher among women who gave birth in a large hospital, women who were over 25 years of age, primigravidae, and women who were not supported by a prenatal instructor during childbirth.
  
  
  CONCLUSIONS
  non-clinical factors considerably affect the type of birth outcome (vaginal vs. CS). A system in which a prenatal instructor provided support to the woman during childbirth could contribute significantly to reducing initial and repeat CS.
authors.affiliation: Department of Reproductive Health, National Institute of Public Health in Mexico, Cuernavaca, Morelos, Mexico. lcampero@correo.insp.mx
authors.forename: Lourdes
authors.initials: L
authors.lastname: Campero
authors.forename: Bernardo
authors.initials: B
authors.lastname: Hernández
authors.forename: Jomo
authors.initials: J
authors.lastname: Osborne
authors.forename: Sara
authors.initials: S
authors.lastname: Morales
authors.forename: Teresa
authors.initials: T
authors.lastname: Ludlow
authors.forename: Christian
authors.initials: C
authors.lastname: Muñoz
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000523:psychology / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D016015:Logistic Models; D008800:Mexico / Q000453:epidemiology; D008880:Midwifery / Q000379:methods / Q000592:standards*; D009035:Mothers / Q000193:education* / Q000523:psychology; D009723:Nurse-Patient Relations; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000379:methods*; D013997:Time Factors