Béhague Dominique P, Victora Cesar G, Barros Fernando C
Department of Social Medicine, Federal University of Pelotas, CP 464-96001-970, Pelotas, Rio Grande do Sul, Brazil.
BMJ. 2002 Apr 20;324(7343):942-5. doi: 10.1136/bmj.324.7343.942.
To investigate why some women prefer caesarean sections and how decisions to medicalise birthing are influenced by patients, doctors, and the sociomedical environment.
Population based birth cohort study, using ethnographic and epidemiological methods.
Epidemiological study: women living in the urban area of Pelotas, Brazil who gave birth in hospital during the study. Ethnographic study: subsample of 80 women selected at random from the birth cohort. Nineteen medical staff were interviewed.
5304 women who gave birth in any of the city's hospitals in 1993.
Birth by caesarean section or vaginal delivery.
In both samples women from families with higher incomes and higher levels of education had caesarean sections more often than other women. Many lower to middle class women sought caesarean sections to avoid what they considered poor quality care and medical neglect, resulting from social prejudice. These women used medicalised prenatal and birthing health care to increase their chance of acquiring a caesarean section, particularly if they had social power in the home. Both social power and women's behaviour towards seeking medicalised health care remained significantly associated with type of birth after controlling for family income and maternal education.
Fear of substandard care is behind many poor women's preferences for a caesarean section. Variables pertaining to women's role in the process of redefining and negotiating medical risks were much stronger correlates of caesarean section rates than income or education. The unequal distribution of medical technology has altered concepts of good and normal birthing. Arguments supporting interventionist birthing for all on the basis of equal access to health care must be reviewed.
调查为何一些女性更倾向于剖宫产，以及分娩医学化的决策是如何受到患者、医生和社会医学环境影响的。
基于人群的出生队列研究，采用人种志和流行病学方法。
流行病学研究：居住在巴西佩洛塔斯市区、在研究期间于医院分娩的女性。人种志研究：从出生队列中随机选取的80名女性的子样本。采访了19名医护人员。
1993年在该市任何一家医院分娩的5304名女性。
剖宫产或阴道分娩。
在两个样本中，来自收入较高和教育水平较高家庭的女性剖宫产的比例均高于其他女性。许多中低收入阶层的女性寻求剖宫产，以避免她们认为因社会偏见导致的低质量护理和医疗忽视。这些女性利用医学化的产前和分娩保健来增加获得剖宫产的机会，特别是如果她们在家庭中有社会权力。在控制家庭收入和母亲教育程度后，社会权力和女性寻求医学化保健的行为与分娩方式仍显著相关。
许多贫困女性选择剖宫产的背后是对护理水平不达标的担忧。与女性在重新定义和协商医疗风险过程中的角色相关的变量，与剖宫产率的相关性比收入或教育程度更强。医疗技术的不平等分配改变了正常分娩的概念。必须重新审视基于平等获得医疗保健而支持对所有人进行干预性分娩的论点。
