Gibbons, L., Belizán, J.M., Lauer, J.A., Betrán, A.P., Merialdi, M. and Althabe, F. (2010) The Global Numbers and Costs of Additionally Needed and Unnecessary Caesarean Sections Performed per Year: Overuse as a Barrier to Universal Coverage. World Health Report, 30.

has been cited by the following article:

• TITLE: Proportion of Cesarean Deliveries According to Hospital Funding in São Paulo Metropolitan Area, Brazil

  AUTHORS: Priscila Ribeiro Raspantini, Zilda Pereira da Silva, Gizelton Pereira Alencar, Bárbara Laisa Alves Moura, Felipe Parra do Nascimento, Laura Cunha Rodrigues, Patrícia Carla dos Santos, Marcia Furquim de Almeida

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

  JOURNAL NAME: Open Journal of Obstetrics and Gynecology, Vol.5 No.14, November 30, 2015

  ABSTRACT: 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.