title: Patterns of deliveries in a Brazilian birth cohort: almost universal cesarean sections for the better-off.
abstract: OBJECTIVE
  To describe the patterns of deliveries in a birth cohort and to compare vaginal and cesarean section deliveries.
  
  
  METHODS
  All children born to mothers from the urban area of Pelotas, Brazil, in 2004, were recruited for a birth cohort study. Mothers were contacted and interviewed during their hospital stay when extensive information on the gestation, the birth and the newborn, along with maternal health history and family characteristics was collected. Maternal characteristics and childbirth care financing - either private or public healthcare (SUS) patients - were the main factors investigated along with a description of C-sections distribution according to day of the week and delivery time. Standard descriptive techniques, Χ² tests for comparing proportions and Poisson regression to explore the independent effect of C-section predictors were the methods used.
  
  
  RESULTS
  The overall C-section rate was 45%, 36% among SUS and 81% among private patients, where 35% of C-sections were reported elective. C-sections were more frequent on Tuesdays and Wednesdays, reducing by about a third on Sundays, while normal deliveries had a uniform distribution along the week. Delivery time for C-sections was markedly different among public and private patients. Maternal schooling was positively associated with C-section among SUS patients, but not among private patients.
  
  
  CONCLUSIONS
  C-sections were almost universal among the wealthier mothers, and strongly related to maternal education among SUS patients. The patterns we describe are compatible with the idea that C-sections are largely done to suit the doctor's schedule. Drastic action is called for to change the current situation.
authors.affiliation: Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brasil. abarros.epi@gmail.com
authors.forename: Aluísio J D
authors.initials: AJ
authors.lastname: Barros
authors.forename: Iná S
authors.initials: IS
authors.lastname: Santos
authors.forename: Alicia
authors.initials: A
authors.lastname: Matijasevich
authors.forename: Marlos Rodrigues
authors.initials: MR
authors.lastname: Domingues
authors.forename: Mariângela
authors.initials: M
authors.lastname: Silveira
authors.forename: Fernando C
authors.initials: FC
authors.lastname: Barros
authors.forename: Cesar G
authors.initials: CG
authors.lastname: Victora
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001938:Brazil; D002585:Cesarean Section / Q000191:economics / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D002648:Child; D015331:Cohort Studies; D005260:Female; D016304:Hospitals, Private / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D009321:Natural Childbirth / Q000191:economics / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013997:Time Factors; D055815:Young Adult