Author(s)

Priscila Ribeiro Raspantini¹, Zilda Pereira da Silva¹, Gizelton Pereira Alencar¹, Bárbara Laisa Alves Moura¹, Felipe Parra do Nascimento², Laura Cunha Rodrigues³, Patrícia Carla dos Santos¹, Marcia Furquim de Almeida¹

¹School of Public Health at University of Sao Paulo, Sao Paulo, Brazil.
²Medical School at University of Sao Paulo, Sao Paulo, Brazil.
³London School of Hygiene and Tropical Medicine, London, UK.

Introduction: There has been an increase in the proportion of cesarean deliveries, especially in developing countries. Methods: Cross-sectional study of all hospital live births from mothers living in Sao Paulo Metropolitan Area, Brazil. Data were obtained from the Live Birth Information System, which is linked to the National Database of Health Establishments. Hospitals were classified as public, private or mixed. Descriptive analysis and exponential regression were conducted to evaluate time trends. Poisson regression was applied to analyze each hospital type to identify risk factors and the attributable risk fraction for cesarean section. Results: There was an annual increase (1.4%) of cesarean deliveries between 2000 and2013. In2009, the percentage of cesarean deliveries was 53% overall and 83% in private hospitals. The primary risk factor for cesarean delivery was delivery in a private hospital. Other risk factors that were stronger in public hospitals included the following: advanced maternal age, high maternal education, nulliparity, high number of prenatal visits, multiple pregnancy, hospital with low annual volume of deliveries, birth outside the city of residence and white skin color. Discussion: These results may be explained by the obstetric care model of private hospitals, which is not multiprofessional. Prenatal care and delivery are conducted by the same doctor and rarely include the input of another professional, such as a midwife. In addition, the mode of delivery influences the professional’s payment.

Cesarean Sections, Risk Factors, Public, Private and Mixed Hospitals, Poisson Regression

Raspantini, P. , da Silva, Z. , Alencar, G. , Moura, B. , do Nascimento, F. , Rodrigues, L. , dos Santos, P. and de Almeida, M. (2015) Proportion of Cesarean Deliveries According to Hospital Funding in São Paulo Metropolitan Area, Brazil. Open Journal of Obstetrics and Gynecology, 5, 799-807. doi: 10.4236/ojog.2015.514113.