The misleading choice for safer births in Brazilian's most developed region: a cross-sectional study

The role of the respectful maternity care model in São Paulo, Brazil: A cross-sectional study

INTRODUCTION

The promotion of a positive birth experience has been a main goal of the World Health Organization's (WHO) recent work on improving maternity care. The purpose of this study was to assess the cesarean rates, the prevalence of birth practices, perinatal outcomes, and maternal satisfaction, in women involved with the respectful maternity care (RMC) support groups in Sao Paulo, Brazil.

METHODS

This was a cross-sectional study of women with low-risk pregnancies who were assisted by professionals recommended by the RMC groups. An online questionnaire was administered. Variables to assess birth practices were classified as positive, negative, or unspecified according to the WHO guidelines. The Pearson chi-square tests and odds ratios (ORs) with their corresponding 95% confidence intervals (CIs) were computed to assess differences between the groups.

RESULTS

Five-hundred and eighty women completed the questionnaire. The cesarean rate was 14.7%, and the operative vaginal birth rate was 9.5%. The VBAC rate was 87.1%, and there was no significant difference in risk for cesarean between women with or without a prior cesarean. Of all women, 83.1% had a midwife's assistance and 75.5% hired a doula; 81.4% gave birth in a nonlithotomic position. The practices of enema, fasting and episiotomy were all under 2%. All 5-minute Apgar scores were ≥7. Most (83.1%) women reported having a positive birth experience.

CONCLUSIONS

Woman's engagement with the birth support groups and a transdisciplinary team focused on RMC are key elements to achieve positive perinatal outcomes and high women's satisfaction.