Increase in cesarean sections in Brazil - a call to reflection - Revista Brasileira de Ginecologia e Obstetrícia
Rev Bras Ginecol Obstet. 2023;45(3):109-112
, , , , , , , , , , , , Cesarean rates have increased progressively over the decades in all countries, and a high figure of 56% was reached in Brazil, second only to the Dominican Republic (59%) and well above the average of developing countries. This scenario in our country motivated government and private sector initiatives, among which the Projeto Parto Adequado (“Adequate Childbirth Project”), with a view to reducing cesarean sections. The set of these actions allowed for a stabilization and even a slight decrease in cesarean section rates according to data from the Information System on Live Births (Portuguese acronym: SINASC) of the Brazilian Ministry of Health. However, preliminary data from SINASC for 2022 pointed to a further increase in cesarean sections in Brazil (cesarean section rates: 2016: 55.4%; 2017: 55.7%; 2018: 55.9%; 2019: 56.3%; 2020: 57.2%; 2021: 57%) and motivated this reflection made by Brazilian obstetric schools.
Undoubtedly, the COVID-19 pandemic has profoundly affected healthcare in Brazil, accelerating trends and highlighting weaknesses. In the obstetric scenario, the country already showed signs of an increase in cesarean rates from 2017 onwards, and the pandemic accentuated this process. Although the healthcare network was reorganized to maintain antenatal care during the pandemic, this was limited in practice, especially for patients at obstetric risk. As a result, pregnant womenarrivedatmaternity hospitalswith obstetric complications in more severe stages and the indication for cesarean sections to alleviate an unfavorable maternal-perinatal outcome. In addition, especially at the beginning of the pandemic, although there was no explicit guidance, many cesarean sectionswere performed under the mistaken belief that this would bring better maternal outcomes. With experience in the management of COVID-19, it was observed that whenever plausible, the resolution should be postponed until clinical stabilization of the pregnant woman. However, in cases with a precise indication of resolution of the pregnancy because of severe conditions, the possible mode of delivery was mostly the cesarean section.
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Cesarean rates have increased progressively over the decades in all countries, and a high figure of 56% was reached in Brazil, second only to the Dominican Republic (59%) and well above the average of developing countries. This scenario in our country motivated government and private sector initiatives, among which the Projeto Parto Adequado (“Adequate Childbirth Project”), with a view to reducing cesarean sections. The set of these actions allowed for a stabilization and even a slight decrease in cesarean section rates according to data from the Information System on Live Births (Portuguese acronym: SINASC) of the Brazilian Ministry of Health. However, preliminary data from SINASC for 2022 pointed to a further increase in cesarean sections in Brazil (cesarean section rates: 2016: 55.4%; 2017: 55.7%; 2018: 55.9%; 2019: 56.3%; 2020: 57.2%; 2021: 57%) and motivated this reflection made by Brazilian obstetric schools.
Undoubtedly, the COVID-19 pandemic has profoundly affected healthcare in Brazil, accelerating trends and highlighting weaknesses. In the obstetric scenario, the country already showed signs of an increase in cesarean rates from 2017 onwards, and the pandemic accentuated this process. Although the healthcare network was reorganized to maintain antenatal care during the pandemic, this was limited in practice, especially for patients at obstetric risk. As a result, pregnant womenarrivedatmaternity hospitalswith obstetric complications in more severe stages and the indication for cesarean sections to alleviate an unfavorable maternal-perinatal outcome. In addition, especially at the beginning of the pandemic, although there was no explicit guidance, many cesarean sectionswere performed under the mistaken belief that this would bring better maternal outcomes. With experience in the management of COVID-19, it was observed that whenever plausible, the resolution should be postponed until clinical stabilization of the pregnant woman. However, in cases with a precise indication of resolution of the pregnancy because of severe conditions, the possible mode of delivery was mostly the cesarean section.
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