Dias Marcos Augusto Bastos, Deslandes Suely Ferreira
Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brasil.
Cad Saude Publica. 2004 Jan-Feb;20(1):109-16. doi: 10.1590/s0102-311x2004000100025. Epub 2004 Mar 8.
The cesarean section rate in municipal public maternity hospitals in the city of Rio de Janeiro in the year of 2000 was 30.1%. With such a high rate, our hypothesis is that attending obstetricians in these units are indicating cesarean sections for reasons not restricted to clinical factors. The article aims to analyze physicians' representations of the inherent risks in cesarean sections that influence the medical decision for their indication. In this qualitative study, conducted through participant observation during ward duty and interviews with obstetricians, we observed that C-section indications by obstetricians are influenced by various non-obstetric factors, including insecurity about performing obstetric maneuvers, fragmented care, and fear of legal liability. The paper suggests that the widespread use of this intervention in private maternity services has fostered a practice in public obstetric services that compromises the quality of public health care and may jeopardize the health of women and infants.
2000年，里约热内卢市公立妇产医院的剖宫产率为30.1%。鉴于这一高比率，我们的假设是，这些机构的产科医生进行剖宫产手术的原因不限于临床因素。本文旨在分析医生对剖宫产固有风险的认知，这些风险会影响剖宫产手术指征的医疗决策。在这项定性研究中，我们通过在病房值班期间的参与观察以及对产科医生的访谈发现，产科医生进行剖宫产手术的指征受到多种非产科因素的影响，包括对实施产科操作的不安全感、护理碎片化以及对法律责任的担忧。该论文指出，这种手术在私立妇产服务机构中的广泛应用，促使公立产科服务形成了一种损害公共卫生保健质量的做法，可能危及妇女和婴儿的健康。
