Cesarean section rates in Lucas do Rio Verde, Brazil: Assessing the impact of socioeconomic status and maternal and neonatal outcomes.

BackgroundBrazil is globally known for its high rate of cesarean section despite endorsing the WHO's current recommendation of 15%.ObjectivesDetermine if socioeconomic status correlated with the rate of cesarean section (CS) at a mixed private and public hospital in the west-central region of Brazil. Describe the maternal and neonatal outcomes by mode of delivery (MOD) in the same population.DesignCohort studyMethodsData from all delivering patients at São Lucas Hospital were collected during an 18-month period and analyzed. Demographics, baseline maternal health status, pregnancy and delivery information, maternal outcomes, and neonatal outcomes were entered into a secure database.ResultsData from 2,103 women who delivered at São Lucas Hospital were collected. 75% of women delivered via CS. 53.7% were elective in nature. Women who had ≥ 8 prenatal visits (OR1.36, 95% CI 1.06- 1.72, p= 0.013) and had insurance type plan (OR 1.88, 95% CI 1.43-2.50, p<0.001) were more likely to undergo CS. Women who worked in the commercial sector were less likely to undergo CS (OR 0.53, 95% CI 0.33-0.90, p= 0.015). Women who were older (OR 1.05, 95% CI 1.03-1.07, p <0.001) and had a high BMI (OR 1.11, 95% CI 1.08-1.13, p<0.001) were more likely to undergo CS. When examining women who underwent CS those women who were white (OR 1.40, 95% CI 1.11-1.78, p=0.005), were older (OR 1.04, 95% CI 1.03-1.06, p<0.001), worked in agriculture (OR 2.06, 95% CI 1.22-3.57, p=0.008), and had insurance type private (OR 1.79, 95% CI 1.22-2.65, p=0.003) or plan (OR 2.47, 95% CI 1.92-3.19, p<0.001) were more likely to have an elective CS. MOD was not associated with maternal or neonatal outcomes.ConclusionCS rates at São Lucas Hospital are high. Socioeconomic factors and maternal demographics were predictive of MOD. Maternal and neonatal outcomes in term deliveries did not differ by MOD.