Birth in Brazil: national survey into labour and birth.
BACKGROUND
Caesarean section rates in Brazil have been steadily increasing. In 2009, for the first time, the number of children born by this type of procedure was greater than the number of vaginal births. Caesarean section is associated with a series of adverse effects on the women and newborn, and recent evidence suggests that the increasing rates of prematurity and low birth weight in Brazil are associated to the increasing rates of Caesarean section and labour induction.


METHODS
Nationwide hospital-based cohort study of postnatal women and their offspring with follow-up at 45 to 60 days after birth. The sample was stratified by geographic macro-region, type of the municipality and by type of hospital governance. The number of postnatal women sampled was 23,940, distributed in 191 municipalities throughout Brazil. Two electronic questionnaires were applied to the postnatal women, one baseline face-to-face and one follow-up telephone interview. Two other questionnaires were filled with information on patients' medical records and to assess hospital facilities. The primary outcome was the percentage of Caesarean sections (total, elective and according to Robson's groups). Secondary outcomes were: post-partum pain; breastfeeding initiation; severe/near miss maternal morbidity; reasons for maternal mortality; prematurity; low birth weight; use of oxygen use after birth and mechanical ventilation; admission to neonatal ICU; stillbirths; neonatal mortality; readmission in hospital; use of surfactant; asphyxia; severe/near miss neonatal morbidity. The association between variables were investigated using bivariate, stratified and multivariate model analyses. Statistical tests were applied according to data distribution and homogeneity of variances of groups to be compared. All analyses were taken into consideration for the complex sample design.


CONCLUSIONS
This study, for the first time, depicts a national panorama of labour and birth outcomes in Brazil. Regardless of the socioeconomic level, demand for Caesarean section appears to be based on the belief that the quality of obstetric care is closely associated to the technology used in labour and birth. Within this context, it was justified to conduct a nationwide study to understand the reasons that lead pregnant women to submit to Caesarean sections and to verify any association between this type of birth and it's consequences on postnatal health.
Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil. duca@fiocruz.br
Maria
M
do Carmo Leal
Antônio Augusto Moura
AA
da Silva
Marcos Augusto Bastos
MA
Dias
Silvana Granado Nogueira
SG
da Gama
Daphne
D
Rattner
Maria Elizabeth
ME
Moreira
Mariza Miranda Theme
MM
Filha
Rosa Maria Soares Madeira
RM
Domingues
Ana Paula Esteves
AP
Pereira
Jacqueline Alves
JA
Torres
Sonia Duarte Azevedo
SD
Bittencourt
Eleonora
E
D'orsi
Antonio Jla
AJ
Cunha
Alvaro Jorge Madeiro
AJ
Leite
Rejane Silva
RS
Cavalcante
Sonia
S
Lansky
Carmem Simone Grilo
CS
Diniz
Célia Landmann
CL
Szwarcwald
D001938:Brazil / Q000453:epidemiology; D001942:Breast Feeding / Q000639:trends; D002585:Cesarean Section / Q000009:adverse effects / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007751:Labor, Induced; D007743:Labor, Obstetric; D008428:Maternal Mortality; D010146:Pain / Q000453:epidemiology; D049590:Postpartum Period; D011247:Pregnancy; D011256:Pregnancy Outcome; D011795:Surveys and Questionnaires