Alonso Bruna Dias, Silva Flora Maria Barbosa da, Latorre Maria do Rosário Dias de Oliveira, Diniz Carmen Simone Grilo, Bick Debra
Universidade de São Paulo. Faculdade de Saúde Pública. Programa de Pós-Graduação em Saúde Pública. São Paulo, SP, Brasil.
Universidade de São Paulo. Faculdade de Saúde Pública. Escola de Artes, Ciências e Humanidades. Departamento de Saúde Materno-Infantil. Graduação em Obstetrícia. São Paulo, SP, Brasil.
Rev Saude Publica. 2017;51:101. doi: 10.11606/S1518-8787.2017051007054. Epub 2017 Nov 17.
To examine maternal and obstetric factors influencing births by cesarean section according to health care funding.
A cross-sectional study with data from Southeastern Brazil. Caesarean section births from February 2011 to July 2012 were included. Data were obtained from interviews with women whose care was publicly or privately funded, and from their obstetric and neonatal records. Univariate and multivariate analyses were conducted to generate crude and adjusted odds ratios (OR) with 95% confidence intervals (95%CI) for caesarean section births.
The overall caesarean section rate was 53% among 9,828 women for whom data were available, with the highest rates among women whose maternity care was privately funded. Reasons for performing a c-section were infrequently documented in women's maternity records. The variables that increased the likelihood of c-section regardless of health care funding were the following: paid employment, previous c-section, primiparity, antenatal and labor complications. Older maternal age, university education, and higher socioeconomic status were only associated with c-section in the public system.
Higher maternal socioeconomic status was associated with greater likelihood of a caesarean section birth in publicly funded settings, but not in the private sector, where funding source alone determined the mode of birth rather than maternal or obstetric characteristics. Maternal socioeconomic status and private healthcare funding continue to drive high rates of caesarean section births in Brazil, with women who have a higher socioeconomic status more likely to have a caesarean section birth in all birth settings.
根据医疗保健资金情况，研究影响剖宫产分娩的孕产妇及产科因素。
采用横断面研究，数据来自巴西东南部。纳入2011年2月至2012年7月的剖宫产分娩病例。数据通过对接受公共或私人资金资助的妇女进行访谈以及她们的产科和新生儿记录获得。进行单因素和多因素分析，以生成剖宫产分娩的粗比值比（OR）和调整后比值比（OR）以及95%置信区间（95%CI）。
在有数据的9828名妇女中，总体剖宫产率为53%，其中产妇护理由私人资助的妇女剖宫产率最高。剖宫产的原因在妇女的产科记录中很少有记载。无论医疗保健资金情况如何，增加剖宫产可能性的变量如下：有偿就业、既往剖宫产史、初产、产前及分娩并发症。产妇年龄较大、大学学历和较高的社会经济地位仅与公共系统中的剖宫产有关。
在公共资助环境中，较高的产妇社会经济地位与剖宫产分娩的可能性增加有关，但在私营部门并非如此，在私营部门，仅资金来源决定分娩方式，而非产妇或产科特征。产妇社会经济地位和私人医疗保健资金继续推动巴西剖宫产分娩率居高不下，社会经济地位较高的妇女在所有分娩环境中更有可能进行剖宫产分娩。
