Introdução - As práticas obstétricas têm sido determinadas pela noção de risco, resultando em altas taxas de intervenções intraparto e de cesarianas no país. As indicações desta cirurgia não têm seguido um critério clínico-obstétrico fundamentado nos diferentes cenários de assistência, reduzindo o seu potencial protetor. Objetivos - Identificar e comparar as indicações de cesarianas intraparto em mulheres de baixo risco, a partir da assistência e das intercorrências que antecederam o nascimento, em dois modelos de assistência (Centro de Parto Normal e Centro Obstétrico); e caracterizar os locais de estudo quanto à equipe de saúde, às práticas protocolares e à estrutura física para assistência à mulher e ao bebê. Métodos - Estudo transversal, realizado por coleta de dados secundários, em dois hospitais públicos de São Paulo. Foram incluídas no estudo 158 parturientes de baixo risco submetidas à cesariana intraparto, em 2010. Para análise dos dados, estimou-se a Odds Ratio. Resultados - Os achados foram discutidos à luz da Medicina Baseada em Evidências. Os melhores resultados estiveram associados ao Hospital que dispõe de Centro de Parto Normal, com significância estatística na internação oportuna da parturiente, na presença de um acompanhante, no uso de partograma e nos métodos não farmacológicos para alívio das dores. Constataram-se alguns registros de práticas obstétricas realizadas de modo questionável em ambas as instituições, como uso de ocitocina e de amniotomia. Quanto às intercorrências, as mais frequentes foram: sofrimento fetal, presença de mecônio, distocia funcional e desproporção céfalo-pélvica, embora parte dessas indicações tenha divergido dos achados registrados no decorrer do trabalho de parto. Considerações finais: Fragilidades nas práticas obstétricas estiveram presentes em ambas as instituições, embora o Hospital com Centro de Parto Normal tenha demonstrado assistência menos restritiva e mais personalizada às mulheres. Evidenciou-se a presença de intervenções desnecessárias, com vistas à aceleração do trabalho de parto, o que demonstra resistência dos profissionais e das instituições às evidências científicas, bem como às recomendações e diretrizes do Ministério da Saúde e da Organização Mundial da Saúde / Background - The obstetrical practices have been determined by the notion of risk, resulting in high rates of intrapartum interventions and cesarean sections in the country. The recommendations of this surgery have not followed a wellfounded clinical and obstetric criterion in different assistance scenarios, reducing its protective potential. Objectives Identify and compare the recommendations for intrapartum caesarean sections in women with low-risk pregnancies from the assistance and the events that preceded the birth, in two models of care (Center for Childbirth and Obstetric Center); and characterize the study sites regarding the health team, protocol practices and the structure to assist the woman and the baby. Methods - A cross sectional study carried out by secondary data collection in two public hospitals in São Paulo. The study included 158 pregnant women with low-risk pregnancies, submitted to intrapartum cesarean section in 2010. For data analysis, we estimated the Odds Ratio. Results The findings were discussed from the Evidence-Based Medicine. The best results were associated with a hospital that has a Childbirth Center, with statistical significance in the timely admission of the mother, in the presence of a companion, the use of partogram and non-pharmacological methods for pain relief. There were records of obstetrical practices in a way questionable in both institutions, such as use of oxytocin and amniotomy. As for complications, the most frequent were: fetal distress, meconium, functional dystocia and cephalopelvic disproportion, although part of these records have diverged from findings reported in the course of labor. Conclusion: Weaknesses in obstetric practices were present in both institutions, although the Hospital Childbirth Center has demonstrated a more personalized and less restrictive care to women. It was noted the presence of unnecessary interventions, aiming at the acceleration of labor, which shows resistance of professionals and institutions to the evidence-based medicine, and also to the recommendations and guidelines of the Ministry of Health and World Health Organization

Introdução. O modelo tecnocrático de assistência ao parto e nascimento propõe uma lógica organizacional com práticas não baseadas em evidências científicas cujos desfechos se contrapõem ao bem-estar materno e infantil. No setor público ocorrem partos com excesso de intervenções e altas taxas de cesarianas. No setor privado, a maioria das mulheres é submetida a cesáreas. Em ambas as situações, pergunta-se a quem e por que é vantajoso o que se prescreve. Objetivos. Revisar sistematicamente a produção científica nacional e internacional que trata das circunstâncias em que o tema dos conflitos de interesses nas indicações de cesárea é abordado. Material e método. Revisão sistemática abrangente da literatura disponível, segundo a metodologia do Instituto Joanna Briggs. Resultados. Foram identificados 4.135 textos em 4 bases de dados - The Cochrane Library, EconPapers, CINAHL e Medline - dos quais 41 foram analisados após a aplicação de critérios.de inclusão. Os idiomas encontrados foram: inglês, francês, português e espanhol, com predominância do primeiro. A maioria trouxe a palavra cesárea entre seus descritores. Foram recorrentes termos ligados à prática de profissionais e às diferentes formas de pagamento ou financiamento da assistência. As influências sobre a decisão por cesárea são abordadas em diferentes análises da assistência. Os principais atores envolvidos são médicos e mulheres. Foi possível identificar conflitos de duas naturezas: financeiros diretos e indiretos e não financeiros. Discussão. A literatura silencia sobre os conflitos de interesses entre provedores de cuidados e mulheres nas decisões por cesárea. Os interesses secundários problematizados nos textos foram nomeados fatores associados a conflito de interesses. A narrativa hegemônica (percepção do médico) se sobrepõe às outras e as obscurece. Conflitos de interesse são omitidos e surgem termos como incentivos financeiros e indução da demanda, frequentemente analisados sem considerar o desnível de poderes entre os atores envolvidos. Conclusões. O fenômeno é apenas implícito na literatura que problematiza os incentivos e a indução da demanda à prática de cesarianas. As circunstâncias são processos de análise da assistência obstétrica que investigam explicações e interferências nas variações das taxas de cesáreas. O ator com maior poder de influenciar o desfecho é o médico. A invisibilidade do conceito na literatura científica aponta para uma lacuna de conhecimento a ser preenchida. / Background. The technocratic model of childbirth care proposes a logical organizational with non-evidence based practices whose outcomes oppose the welfare of both mother and child. In the public sector births occur with excessive interventions and high rates of caesarean section. In the private sector, the majority of women are subjected to caesarean sections. In both situations, the question is to whom and why it is advantageous to perform those practices. Objectives. To review systematically national and international scientific literature which addresses the circumstances in which the issue of conflicts of interest in indications for cesarean section is approached Material and method. Comprehensive systematic review of the available literature, according to the methodology of the Joanna Briggs Institute. Results. 4,135 texts were identified in four data bases The Cochrane Library, EconPapers, CINAHL, Medline - of which 41 were analyzed after applying inclusion criteria. Languages found were English, French, Portuguese and Spanish, English being the most common. Most brought the word \"cesarean\" among their key terms. Recurrent terms were related to professional practice and the different forms of payment or financing healthcare. The influences on the decision for cesarean section are addressed in different healthcare analysis. The main actors involved are doctors and women. It was possible to identify conflicts of two natures: financial - direct and indirect - and non-financial. Discussion. Literature is silent about the conflicts of interest between care providers and women on decisions for cesarean sections. The secondary interests approached in the texts were named \"factors associated with conflict of interests.\" The hegemonic narrative (physicians perception) overlaps and obscures all others. Conflicts of interest are omitted and other terms such as financial incentives and supplier induced demand are often analyzed without considering the difference of power between the actors involved. Conclusions. The phenomenon is only implicit in the literature that discusses incentives and provider induced demand over the practice of cesarean sections. The circumstances are processes of analysis of obstetric care which investigate explanations and interferences on variations of cesarean section rates. The actor with the greatest power to influence the outcome is the doctor. The invisibility of the concept in the literature points out to a knowledge gap to be filled

O parto cesariano tem sido usado de forma abusiva no Brasil. Fatores socioeconômicos, culturais e de organização dos serviços de saúde colaboram para a grande proporção de partos cirúrgicos, muitas vezes sem indicação médica que a justifique. Objetivo: avaliar a associação independente de variáveis socioeconômicas e demográficas maternas, características da assistência à gestação e parto e características do parto com o tipo de parto (vaginal e cirúrgico) e também com a causa da cesariana, classificada como terapêutica (doença ou condição materna ou fetal) e eletiva (sem causa médica expressa), em comparação ao parto vaginal. Método: Foram utilizados dados coletados de todas as puérperas do município de Ribeirão Preto, SP, em 2010, 7568 mães de recém-nascidos vivos de parto único. Na análise descritiva utilizou-se o teste de qui-quadrado e a associação dos fatores descritos com tipo de parto (vaginal e cirúrgico) foi testada por análise de Poisson com ajuste robusto da variância. A associação entre cesariana terapêutica ou eletiva e parto vaginal com as variáveis de interesse foi testada em análise de regressão logística multinomial. Resultados: Cesárea ocorreu em 58,4% dos partos, dos quais 58,3% foram terapêuticas e 41,7% eletivas; de todos os partos, 33,8% foram cesáreas terapêuticas e 24,3% foram eletivas. Após ajuste, cesárea foi mais frequente que parto vaginal nas gestações terminadas antes de 39 semanas, em mães adolescentes, com 9 a 11 anos de estudo, que realizaram partos no setor privado, depois de 12 horas decorridas entre internação e parto e internaram sem trabalho de parto; foi menos frequente de madrugada, às sextas-feiras, sábados e domingos, entre três e cinco horas da internação, em mães não brancas, que não realizaram pré-natal e parto com o mesmo médico e primíparas. Cesárea terapêutica foi mais frequente que o parto vaginal em gestações terminadas prematuramente; foi menos frequente que o parto vaginal de quinta-feira a domingo, entre três e 11 horas de internação, em gravidez não planejada e em multíparas. Cesáreas eletivas foram mais frequentes nas gestações entre 37-38 semanas, entre mães com 5 a 11 anos de estudo e multíparas com 2 a 4 partos; foram menos frequentes em mães idosas, nas classes menos favorecidas e com tempo de internação até o parto maior que três horas. Tanto as terapêuticas como eletivas foram mais frequentes do que parto vaginal em mães adolescentes, parto ocorrido no setor privado e fora do trabalho de parto. Ambas foram menos frequentes do que parto vaginal em mães, não brancas, partos realizados de madrugada e de quinta-feira a domingo e quando não foi o mesmo médico do pré- natal e parto. Conclusão: A taxa de cesárea em Ribeirão Preto apresentou valores expressivos, sendo 1/4 deles eletivos. Cesárea foi associada a características socioeconômicas da população estudada e também a fatores não clínicos, como assistência privada ao parto, dia e hora do nascimento. Algumas dessas características são comuns à cesárea terapêutica e eletiva, sugerindo que, mesmo com razões biológicas definindo a cesárea como terapêutica, fatores não clínicos podem ser mais importantes para decidir sobre a realização da cirurgia. / The caesarean section has been overused in Brazil. Socioeconomic, cultural and organization of health services factors contribute to the high proportion of surgical deliveries, often without medical indication to justify it. To assess the independent association of socioeconomic and maternal demographic variables, assistance features to pregnancy and labor and delivery characteristics of the type of delivery (vaginal and surgical) and also to the cause of cesarean section, classified as therapy (disease or maternal condition or fetal) and elective (without medical cause expressed) compared to vaginal delivery. We used data collected from all the mothers of Ribeirão Preto, SP, in 2010, 7568 mothers of live births of single birth. In the descriptive analysis was performed using the chi-square test and the combination of the factors described in the type of delivery was tested by Poisson analysis with robust adjustment of the variance. The association between therapeutic or elective cesarean section and vaginal delivery with the variables of interest was tested in multinomial logistic regression analysis. Cesarean occurred in 58.4% of births, of which 58.3% were therapeutic and 41.7% elective; of all births, 33.8% were therapeutic cesarean and 24.3% were elective. After adjustment, cesarean sections were more frequent than vaginal birth pregnancies ending before 39 weeks in teenage mothers, with 9 to 11 years of study, who underwent births in the private sector after 12h elapsed between admission and delivery and interned without labour; It was less frequent at dawn on Fridays, Saturdays and Sundays, between three and five hours of hospitalization in non-white mothers, who did not undergo prenatal and delivery with the same doctor and gilts. Cesarean therapy was more common than vaginal delivery in prematurely terminated pregnancies; It was less frequent than vaginal delivery Thursday to Sunday from 3 to 11 hours of hospitalization in unplanned pregnancies and multiparous. Elective cesareans were more common in pregnancies between 37- 38 weeks between mothers with 5 to 11 years of study and multiparous with 2-4 deliveries; They were less common in older mothers in the lower classes and length of stay to the higher birth than three hours. Both therapeutic and electives were more common than vaginal delivery in teenage mothers, birth occurred in the private sector and outside labor. Both were less frequent than vaginal delivery in mothers, not white, carried out early morning deliveries and from Thursday to Sunday and when it was not the same doctor\'s prenatal care and childbirth. The rate of cesarean delivery in Ribeirão Preto presented significant values, and 1/4 of them elected. Cesarean section was associated with socioeconomic characteristics of the population studied and also the non-clinical factors, such as private delivery care, day and time of birth. Some of these features are common to therapy and elective caesarean section, suggesting that even with biological reasons defining cesareans as a therapeutic, nonclinical factors may be more important to decide on the surgery.

Abstract available through Circulation.

Cesarean section (CS) rates have generally increased across the world in the past decade. Reducing elective cesarean section (ECS) rates is imperative as many countries aim to maintain threshold CS rates at or below 15%, the level recommended by the United States' National Institutes of Health. Women are believed to consider ECS for various interconnected psychosocial reasons, but few quantitative studies have investigated these factors. This prospective cohort study was based on the social ecological model (SEM) and the theory of planned behavior (TPB) models, and identified the psychosocial predictors of ECS among 1,268 expectant women in 2 hospitals in Nairobi. Participants completed a structured questionnaire consisting of 10 validated psychosocial scales and were followed for actual mode of delivery (MoD) from hospital records and postnatal telephone interviews. The overall prevalence of CS and ECS were 16.0% and 6.4%, respectively; the CS rate was not statistically higher than the recommended 15% (p > 0.05). The combined CS incidence rate for these 2 hospitals was 83 per 1,000 births per month. Autonomy, fear of childbirth, pregnancy related anxiety, perceived social support from friends, and outcome expectancy for birth were statistically significant predictors of ECS, given the parity and age at first pregnancy, Ï?2(df = 19) = 77.735, p

This project is concerned with obstetric complications and cesarean births in a Yucatec Maya community that has recently began interacting with global market economies and Western biomedicine. ​This research engages with maternal health, reproductive biology, colonial histories, and the global trend of increasing cesarean births. The Yucatec Maya are a short statured population [average adult female height 2010 = 143.2 cm] with historically low obstetric complications and maternal mortality. In the last 30 years, CS rates have risen to account for 25% of all births in this community. Because extreme short stature for population has been linked to obstructed labor and birth complications, this project was designed to determine if stature is impacting the rising rate of CS. Reproductive outcomes and obstetric complications were modeled against height in 3 age cohorts of mothers using one-way ANOVA with a Bonferroni-post hoc test and univariate general linear models. No statistical evidence was found to indicate that stature is related to reproductive outcomes or obstetric complications; however, there is an association between short stature and likelihood of cesarean birth. The dramatic change in birth mode in this population may be attributed to increased availability of biomedical resources, doctor-driven perceptions of indigenous women, and low capacity of rural public hospitals to serve numerous patients in labor.

Cesarean delivery is one of the most frequently performed surgical procedures in the United States with 1 in 3 women giving birth by cesarean section. Nurses play a significant role during the labor and delivery process; yet in a hospital in west Texas, nurses lacked knowledge of the current evidence-based obstetric guidelines that were developed to reduce the primary cesarean delivery rates and associated complications. The purpose of this project was to evaluate the content of educational materials developed to inform obstetrical nurses and midwives about labor support strategies to avoid cesarean delivery. Guided by Knowles's whole-part-whole model, a presentation was developed that included evidence-based guidelines and labor-support strategies for positioning and pain management to decrease the choice of cesarean section when not indicated. A 9-member panel with at least 5 years obstetrical expertise evaluated the materials. Based on a descriptive analysis of questionnaire data, experts had a 100% level of agreement that while the educational program material had the potential to promote nursing care practices that would decrease the number of primary cesarean deliveries, changing clinical delivery practices would likely be met with staff resistance. An evidence-based educational program with preventive strategies to decrease primary cesarean deliveries might produce positive social change by prompting obstetric teams to choose these preferred alternatives to avoid to cesarean delivery, and subsequently, decrease associated complication rates, promote faster maternal recovery after childbirth, and decrease the financial burden on the health care system.

Approximately 35.1% of live births for the state of Georgia were delivered by the cesarean delivery procedure with significant variation among hospitals. The purpose of this research was to develop a population-based hospital profiling methodology for study of the cesarean delivery procedure. This was a retrospective, observational design, using a 2012 linked dataset that included maternity deliveries from all nonfederal hospitals. The research was guided by Robson 10 Group Classification System, propensity score methodologies, and ethical precepts, for the development of hospital profiles and the study of variations in the cesarean delivery procedure. Key research questions aimed to determine whether hospital profiling methodologies differed according to risk adjustment methods and statistical techniques. Propensity score matching with stratification methods aimed to determine whether there were differences in patient treatment effects on the cesarean delivery outcome. Findings suggested there was a significant difference in hospital ranks and model effects according to the statistical technique and the risk adjustment methods applied. Propensity score matching with stratification demonstrated an increased risk of the cesarean delivery procedure across strata, with the majority of high risk patients situated in the 90th percentile ranges and questionable utilization practice among other strata. Applying profiling methodologies at the facility and population level could advance statewide quality improvement programs for the timely reduction in the variation of inappropriate utilization of the cesarean delivery procedure.

<p>För det nyfödda barnet är det viktigt att direkt få hud mot hud kontakt och därmed en bra möjlighet att knyta an till sina föräldrar. En tidig anknytning ligger till grund för barnets utveckling och välbefinnande. Efter ett kejsarsnitt separeras mamman och barnet de första timmarna postpartum. Denna studie var en beskrivande litteraturstudie med syfte att beskriva om anknytningen påverkas mellan föräldrar och barn efter ett kejsarsnitt. Relevant litteratur har söks genom databaserna Medline och Cinahl. Urvalskriterierna var att artiklarna svarade på studiens syfte, var skrivna på engelska och hade abstrakt. 18 artiklar valdes som har granskats och kvalitetsbedömts. De flesta studier var kvantitativa och jämförande. Resultatet redovisades i en figur, löpande text och i en tabell. Studien har visat på flera negativa tendenser under den första tiden efter förlossningen som försenad anknytning och amning. Mamman hade även svårigheter att sköta om barnet under de första dagarna postpartum vilket gav pappan en mer framträdande roll. Den första tiden efter förlossningen är en viktig tidpunkt för anknytningen. Det är därför viktigt att vårdpersonal har kännedom om anknytningsteorin och vet hur de ska arbeta för att stärka och stötta familjen den första tiden så att familjen får en god anknytning och en bra start.</p> / <p>For the newborn child it is important that directly have skin to skin connection and thereby a good ability to bond with his parents. An early attachment is very important for the child’s wellbeing and comfort. After a cesarean delivery mother and child are separated the child’s first hours in life. The purpose of this review literature study was to find out if the attachment between the child and the patents affects after a cesarean delivery. Relevant literature has been found in the Medline and the Cinahl databases. The criteria of selection where that the study’s responded to this study’s purpose, that they where written in English and had an abstract. 18 study’s where chosen and has been revised and quality judged. Most of the study’s where quantitative and comparative. The result is shows in a figure, running text and in a table. The study has shown several negative tendencies during the postpartum period such as bonding delay and later breast-feeding establishment. The mother had also difficulties to take care of her child the first day’s postpartum witch gave the father a more leading role in the caretaking activities. The first day’s postpartum is crucial for the attachment and it is important that caregivers has knowledge about the attachment theory and that they know how to strengthening and support the family so they can establish a fine bonding and attachment.</p>

För det nyfödda barnet är det viktigt att direkt få hud mot hud kontakt och därmed en bra möjlighet att knyta an till sina föräldrar. En tidig anknytning ligger till grund för barnets utveckling och välbefinnande. Efter ett kejsarsnitt separeras mamman och barnet de första timmarna postpartum. Denna studie var en beskrivande litteraturstudie med syfte att beskriva om anknytningen påverkas mellan föräldrar och barn efter ett kejsarsnitt. Relevant litteratur har söks genom databaserna Medline och Cinahl. Urvalskriterierna var att artiklarna svarade på studiens syfte, var skrivna på engelska och hade abstrakt. 18 artiklar valdes som har granskats och kvalitetsbedömts. De flesta studier var kvantitativa och jämförande. Resultatet redovisades i en figur, löpande text och i en tabell. Studien har visat på flera negativa tendenser under den första tiden efter förlossningen som försenad anknytning och amning. Mamman hade även svårigheter att sköta om barnet under de första dagarna postpartum vilket gav pappan en mer framträdande roll. Den första tiden efter förlossningen är en viktig tidpunkt för anknytningen. Det är därför viktigt att vårdpersonal har kännedom om anknytningsteorin och vet hur de ska arbeta för att stärka och stötta familjen den första tiden så att familjen får en god anknytning och en bra start. / For the newborn child it is important that directly have skin to skin connection and thereby a good ability to bond with his parents. An early attachment is very important for the child’s wellbeing and comfort. After a cesarean delivery mother and child are separated the child’s first hours in life. The purpose of this review literature study was to find out if the attachment between the child and the patents affects after a cesarean delivery. Relevant literature has been found in the Medline and the Cinahl databases. The criteria of selection where that the study’s responded to this study’s purpose, that they where written in English and had an abstract. 18 study’s where chosen and has been revised and quality judged. Most of the study’s where quantitative and comparative. The result is shows in a figure, running text and in a table. The study has shown several negative tendencies during the postpartum period such as bonding delay and later breast-feeding establishment. The mother had also difficulties to take care of her child the first day’s postpartum witch gave the father a more leading role in the caretaking activities. The first day’s postpartum is crucial for the attachment and it is important that caregivers has knowledge about the attachment theory and that they know how to strengthening and support the family so they can establish a fine bonding and attachment.