Brazilian women and physicians' viewpoints on their preferred route of delivery

Abstract

OBJECTIVE: To describe women's preferred route of delivery and physicians' viewpoint on that. METHODS: A total of 656 women who gave birth in the National Health System hospitals of the state of São Paulo and Pernambuco and were enrolled in the Latin American Cesarean Section Study (ELAC) were interviewed. Of them, 230 women were selected from three intervention hospitals where patients routinely sought a second opinion when faced with the decision of undergoing a cesarean section, and 426 women were selected from control hospitals. Also, 72 physicians in the intervention hospitals and 70 in the control hospitals filled out a self-administered structured questionnaire. Data analysis was carried out using Mantel-Haenszel's chi-square test, Yates' test and Fischer's exact test. RESULTS: The majority of women reported preferring vaginal delivery than a cesarean section in both groups of hospitals. This preference was significantly higher among women who had had both vaginal delivery and cesarean section (nearly 90% in both groups of hospitals) compared to those who had cesarean sections only (72.8% in intervention hospitals and 77.8% in control hospitals). According to 45% physicians from intervention hospitals and 55% from control hospitals, most women who underwent cesarean sections are satisfied with that; 81% and 85% physicians from intervention and control hospitals, respectively, believed women prefer a cesarean sections out of fear of vaginal deliveries. CONCLUSIONS: The belief that the main reason for increasing cesarean section rates is fulfilling women's desire by their doctors seems to have no support. Better communication between physicians and pregnant women could possibly contribute to improve the current situation.