title: Association between prenatal and parturition in the supplementary health network and elective cesarean section.
abstract: OBJECTIVE
  To identify socio-demographic factors, characteristics and pregnancy complications associated with elective cesarean section.
  
  
  METHODS
  Cross-sectional study. A total of 1,295 births in the first semester of 2012 in Botucatu, São Paulo, Brazil, were evaluated in a large epidemiological study of maternal and child morbidity and mortality. This article compares women who had normal births (n = 405) with 214 undergoing elective cesarean section, defined as scheduled and without reference in hospital records or prenatal card of absolute, relative indication or any medical reason for that. Data were obtained from hospital records, prenatal card and interview with women, soon after parturition. Univariate analysis was conducted and evaluated by Fisher's exact or χ2 tests. Variables with p < 0.20 were grouped into three blocks and, by hierarchical multiple logistic regression model, the associated factors with elective cesarean section were identified, considering p < 0.05.
  
  
  RESULTS
  Socio-demographic variables (age ≥ 18 years, ≥ high school education, paid work and living with a partner) were independently associated with increased odds of elective cesarean section. Regardless of these, there was an association between elective caesarean section and prenatal and place of birth, with a higher chance of birth by elective caesarean section when the woman was assisted by the supplementary health network. Taking as indicators of unfavorable socioeconomic conditions the low education, the payment of prenatal and childbirth by the Unified Health System, it can be said that there was an association between elective caesarean section and better socio-economic conditions.
  
  
  CONCLUSIONS
  Actions in the supplementary health network are required to approach the cesarean delivery rate in the municipality to the international recommendations.
authors.affiliation: Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brazil.
authors.forename: Anna Paula
authors.initials: AP
authors.lastname: Ferrari
authors.affiliation: Departamento de Enfermagem, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brazil.
authors.forename: Maria Antonieta de Barros Leite
authors.initials: MA
authors.lastname: Carvalhaes
authors.affiliation: Departamento de Enfermagem, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brazil.
authors.forename: Cristina Maria Garcia de Lima
authors.initials: CM
authors.lastname: Parada
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D036801:Parturition; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011295:Prenatal Care; D012959:Socioeconomic Factors; D055815:Young Adult