How obstetricians and pregnant women decide mode of birth in light of a recent regulation in Brazil

Women Birth. 2018 Oct;31(5):e310-e317. doi: 10.1016/j.wombi.2017.11.011. Epub 2017 Dec 8.

Abstract

Background: In Brazil, 88% of births among women with private insurance are caesarean sections, even though a caesarean rate above 15% is associated with greater maternal and child morbidity and mortality. Aiming to reduce unnecessary caesarean sections in the private sector, in July 2015 the Brazilian government enacted Resolução Normativa 368, a regulation requiring the use of partograms, pre-natal cards to document pregnancies, and consent forms for elective caesareans, and recommending that obstetricians provide women with an informational letter about birth.

Aims: This study aimed to describe Brazilian women's experiences deciding their mode of birth and obstetricians' roles in this decision-making process after Resolução Normativa 368's enactment.

Methods: Interviews were conducted with obstetricians (n=8) and women who had recently given birth (n=19) in Pelotas, Brazil, and the constant comparative method was used to identify emergent themes.

Findings: Resolução Normativa 368's provisions do not appear to affect decision-making about birth mode. Reportedly, consent forms were rarely used, and were viewed as bureaucratic formalities. Obstetricians described consistent use of pre-natal cards and partograms, but all participants were unaware of informational letters about birth. Moreover, women viewed caesarean sections as a way to avoid pain, and obstetricians felt that vaginal birth's long duration, unpredictability, and low remuneration contribute to high caesarean section rates.

Conclusions: Improved enforcement of Resolução Normativa 368, accompanied by structural changes like an on-call schedule and higher compensation for vaginal births in the private sector, could better inform patients about modes of birth and incentivise physicians to encourage vaginal birth.

Keywords: Brazil; Caesarean birth; Obstetrics; Pregnancy; Vaginal birth.

MeSH terms

  • Adult
  • Attitude of Health Personnel
  • Brazil
  • Cesarean Section
  • Choice Behavior*
  • Decision Making*
  • Elective Surgical Procedures
  • Female
  • Humans
  • Interviews as Topic
  • Obstetrics
  • Parturition / psychology*
  • Physicians*
  • Pregnancy
  • Pregnant Women / psychology*
  • Qualitative Research
  • Vaginal Birth after Cesarean / psychology*