Can the number of cesarean sections be reduced without risk? An analysis of rates and indications in a university clinic

[On the hypothesis of cesarean birth rate stabilization in southeastern, Brazil]

Births in S. Paulo State (Brazil) between 1987 and 1993 were studied to test the association between cesarean section rates and the social and economic development. The study used both Health Regions and hospitals as units of analysis. The cross-sectional study of secondary data adopted as variables: cesarean section rates in 1987, 1992 and 1993 by hospital and region; kind of provider; link of hospital with medical school; post-neonatal infant mortality rate; number of banks per inhabitant; and consumption potential of the regional central town per inhabitant. The C-section rates in the period studied were around 48% for the State; between 21.3 and 85.5% for the regions; between zero and 100% for the hospitals; as for kind of provider, the higher rates were found in private hospitals (56% in 1993). Medical school hospitals held stable rates throughout the period, around 39%. The multiple linear regression showed that banks per inhabitant and consumption potential by inhabitants explained 48% of the variation of the regional C-section rates. The stabilization of the State C-section rates is questioned, since the data shows a shift in the mode of hospital rates to higher values. A re-structure of the care delivered to births is imperative in S. Paulo State, since cesarean sections, besides being medical procedures, have become a consumer good, a symptom of the perverse logic that pervades the current organization of the health system.

Cesarean section odds ratios

Cesarean section (CS) rates for primiparas, multiparas with and without previous CS were investigated in seven obstetrical settings. Despite the great diversity of global CS rates (5.3 to 17.4%), common CS odds ratios of 3.0 and 37 have been found for primiparas and multiparas with previous CS, respectively. Internal links between CS odds ratios have also been investigated for some anomalies associated with CS (fetal distress, non-vertex presentation, hypertension, dystocia, small for dates new born and prematurity), suggesting that perinatal services may be evaluated on CS aspects according to a single general interventionist/conservative clinical attitude. Data from two additional obstetrical settings were used to verify the findings in terms of perinatal evaluation.