title: Caesarean section and neonatal outcomes in private hospitals in Brazil: comparative study of two different perinatal models of care.
abstract: This study aims at comparing caesarean section rates and neonatal outcomes of two perinatal models of care provided in private hospitals in Brazil. Birth in Brazil data, a national hospital-based cohort conducted in the years 2011/2012 was used. We analysed 1,664 postpartum women and their offspring attended at 13 hospitals located in the South-east region of Brazil, divided into a "typical"--standard care model and "atypical"--Baby-Friendly hospital with collaborative practices between nurse-midwives and obstetricians on duty to attend deliveries in an alternative labour ward. The Robson's classification system was used to compare caesarean sections, which was lower in the atypical hospital (47.8% vs. 90.8%, p<0.001). Full term birth, early skin-to-skin contact, breastfeeding in the first hour, rooming-in care, and discharge in exclusive breastfeeding were more frequent in the atypical hospital. Neonatal adverse outcome did not differ significantly between hospitals. The atypical hospital's intervention should be further evaluated since it might reduce caesarean section prevalence and increase good practices in neonatal care.
authors.affiliation: Agência Nacional de Saúde Suplementar, Rio de Janeiro, Brasil.
authors.forename: Jacqueline Alves
authors.initials: JA
authors.lastname: Torres
authors.affiliation: Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
authors.forename: Rosa Maria Soares Madeira
authors.initials: RM
authors.lastname: Domingues
authors.affiliation: Division of Women?s Health, King?s College London, London, England.
authors.forename: Jane
authors.initials: J
authors.lastname: Sandall
authors.affiliation: Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal.
authors.forename: Zulmira
authors.initials: Z
authors.lastname: Hartz
authors.affiliation: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
authors.forename: Silvana Granado Nogueira da
authors.initials: SG
authors.lastname: Gama
authors.affiliation: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
authors.forename: Mariza Miranda
authors.initials: MM
authors.lastname: Theme Filha
authors.affiliation: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
authors.forename: Arthur Orlando Correa
authors.initials: AO
authors.lastname: Schilithz
authors.affiliation: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
authors.forename: Maria do Carmo
authors.initials: Mdo C
authors.lastname: Leal
mesh_terms: D000328:Adult; D001938:Brazil; D001942:Breast Feeding; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D016304:Hospitals, Private / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D018743:Perinatal Care / Q000592:standards; D011247:Pregnancy; D012959:Socioeconomic Factors; D059039:Standard of Care; D055815:Young Adult