title: [Time trend of the rates of cesarean and vaginal delivery according to the source of financing].
abstract: OBJECTIVE
  To analyze the time trend of the rates of cesarean and vaginal delivery according to the source of financing.
  
  
  METHODS
  This was an ecological study of the time series analysis of cesarean and vaginal delivery rates according to the financing source, carried out in Maringá, Paraná State, Brazil, from 2002 to 2012. Information available at the System of Information on Live Births and at the System of Hospital Information of the Brazilian Unified Health System (SUS) was used for data collection. Moving averages were calculated for all mode of delivery rates in order to smooth random fluctuations in the series, dispersion diagrams were designed between the coefficients and years of the study, and polynomial regression models were estimated from the functional relation observed, with the level of significance set at p<0.05.
  
  
  RESULTS
  Throughout the 11 years of the study there were 48,210 births, 77.1% by cesarean delivery and only 22.9% by vaginal delivery. A total of 22,366 procedures were financed by SUS, 54.6% of them being cesareans. Trend analysis was significant for all the regression models, demonstrating an ascending trend for cesarean delivery and a descending trend for vaginal delivery for both types of financing. The non-SUS cesarean rates always exceeded 90.0% and were more frequent than the SUS cesarean rates, even with a 36.0% increase of the latter during the study period.
  
  
  CONCLUSIONS
  Based on trend analysis, cesarean deliveries will continue to increase in both health financing sources unless new actions and strategies of reduction are implemented, involving the sociocultural, demographic and obstetric characteristics of women, the training and activity of professionals in the area of obstetrics and an adequate structure of health services for providing vaginal delivery.
authors.affiliation: Universidade Estadual do Oeste do Paraná - Unioeste, Francisco Beltrão, PR, Brasil.
authors.forename: Gisele Ferreira
authors.initials: GF
authors.lastname: Paris
authors.affiliation: Hospital Universitário de Maringá, Universidade Estadual de Maringá - UEM, Maringá, PR, Brasil.
authors.forename: Lorenna Vlccentine Coutinho
authors.initials: LV
authors.lastname: Monteschio
authors.affiliation: Universidade Estadual de Maringá - UEM, Maringá, PR, Brasil.
authors.forename: Rosana Rosseto
authors.initials: RR
authors.lastname: de Oliveira
authors.affiliation: Universidade de São Paulo - USP, São Paulo, SP, Brasil.
authors.forename: Maria do Rosário Dias de Oliveira
authors.initials: Mdo R
authors.lastname: Latorre
authors.affiliation: Universidade de São Paulo - USP, São Paulo, SP, Brasil.
authors.forename: Sandra Marisa
authors.initials: SM
authors.lastname: Pelloso
authors.affiliation: Universidade de São Paulo - USP, São Paulo, SP, Brasil.
authors.forename: Thais Aidar de Freitas
authors.initials: TA
authors.lastname: Mathias
mesh_terms: D001938:Brazil; D002585:Cesarean Section / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D036861:Delivery, Obstetric / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends*; D005260:Female; D006801:Humans; D011247:Pregnancy; D013997:Time Factors