Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brasil.
Rev Saude Publica. 2011 Aug;45(4):635-43. doi: 10.1590/s0034-89102011005000039. Epub 2011 Jun 10.
To describe the patterns of deliveries in a birth cohort and to compare vaginal and cesarean section deliveries.
All children born to mothers from the urban area of Pelotas, Brazil, in 2004, were recruited for a birth cohort study. Mothers were contacted and interviewed during their hospital stay when extensive information on the gestation, the birth and the newborn, along with maternal health history and family characteristics was collected. Maternal characteristics and childbirth care financing - either private or public healthcare (SUS) patients - were the main factors investigated along with a description of C-sections distribution according to day of the week and delivery time. Standard descriptive techniques, Χ² tests for comparing proportions and Poisson regression to explore the independent effect of C-section predictors were the methods used.
The overall C-section rate was 45%, 36% among SUS and 81% among private patients, where 35% of C-sections were reported elective. C-sections were more frequent on Tuesdays and Wednesdays, reducing by about a third on Sundays, while normal deliveries had a uniform distribution along the week. Delivery time for C-sections was markedly different among public and private patients. Maternal schooling was positively associated with C-section among SUS patients, but not among private patients.
C-sections were almost universal among the wealthier mothers, and strongly related to maternal education among SUS patients. The patterns we describe are compatible with the idea that C-sections are largely done to suit the doctor's schedule. Drastic action is called for to change the current situation.
描述一个出生队列的分娩模式，并比较阴道分娩和剖宫产。
所有在 2004 年出生于巴西佩洛塔斯市区的母亲的孩子都被招募参加了一项出生队列研究。当母亲在住院期间，会对其进行访谈，以获取广泛的信息，包括妊娠、分娩和新生儿情况，以及母亲的健康史和家庭特征。调查的主要因素是产妇特征和分娩护理的资金来源，包括私人或公共医疗保健（SUS）患者，以及根据分娩日和分娩时间描述剖宫产的分布情况。本研究采用标准描述性技术、比较比例的卡方检验和 Poisson 回归来探索剖宫产预测因素的独立影响。
总的剖宫产率为 45%，SUS 为 36%，私人患者为 81%，其中 35%的剖宫产为选择性剖宫产。剖宫产在周二和周三更为常见，周日减少了约三分之一，而正常分娩在一周内分布均匀。剖宫产的分娩时间在公共和私人患者之间有明显差异。SUS 患者中，产妇教育与剖宫产呈正相关，但在私人患者中则不然。
在较为富裕的母亲中，剖宫产几乎是普遍的，而且与 SUS 患者的母亲教育密切相关。我们描述的模式与剖宫产主要是为了适应医生的日程安排的观点是一致的。需要采取果断行动来改变当前的局面。
