title: [The position of the Brazilian Federal Board of Medicine on incentives for reimbursement of childbirth care and the impact on cesarean rates].
abstract: This study analyzed incentives for reimbursement of childbirth care advocated by the Brazilian Federal Board of Medicine (CFM) and their impact on cesarean rates. A consecutive sample of 600 postpartum women was surveyed. The overall cesarean rate was 59.2%, as compared to 92.3% among women that had the same physician for their prenatal care and childbirth. Cesarean rates were significantly greater in the groups of women with higher prevalence of the same physician during prenatal care and delivery, that is, higher rates were associated with older maternal age (PR = 1.65), more schooling (PR = 1.25), prenatal care in the private sector (PR = 1.39) or through private health plans (PR = 1.43), previous cesarean section (PR = 2.78), and admission earlier in labor (PR = 1.93). The results challenge the position by the CFM that financial incentives for women to have the same obstetrician during prenatal care and labor would encourage normal childbirth, when these women are precisely the ones with the highest cesarean rates.
authors.affiliation: Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, Brasil.
authors.forename: Paulo Fontoura
authors.initials: PF
authors.lastname: Freitas
authors.affiliation: Universidade do Sul de Santa Catarina, Tubarão, Brasil.
authors.forename: Bianca Carvalho
authors.initials: BC
authors.lastname: Moreira
authors.affiliation: Universidade do Sul de Santa Catarina, Tubarão, Brasil.
authors.forename: Andre Luciano
authors.initials: AL
authors.lastname: Manoel
authors.affiliation: Universidade do Sul de Santa Catarina, Tubarão, Brasil.
authors.forename: Ana Clara de Albuquerque
authors.initials: AC
authors.lastname: Botura
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil; D002585:Cesarean Section / Q000191:economics* / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D036801:Parturition; D010817:Physician-Patient Relations; D011247:Pregnancy; D011295:Prenatal Care; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult