According to data from the Live Birth Information System (Sinasc), 39% of the deliveries in Brazil are by means of a cesarean section. This rate is way higher than the 15% recommended by the World Health Organization (WHO). This is considered a worrisome reality by the Ministry of Health, as the surgery involves risks for both the mother and the baby.

The project entitled “Epidemiological inquiry on the consequences of unnecessary cesarean section in Brazil”, supported by Fiotec, intends to identify the determinant factors, the magnitude, and the adverse effects resulting from this type of surgery, which is performed unnecessarily in Brazil. The purpose is drawing the attention of healthcare professionals to the current delivery model, and propose changes in the Brazilian obstetric practice.

The coordinator of the project, Maria do Carmo Leal, an Epidemiology Professor for the Post-Graduation Program at Ensp, and health assistance service researcher, explained that the inquiry is about to be have its data collection phase completed. Data was collected from all Brazilian states, in public hospitals, private hospitals and semi-public hospitals.

The inquiry included interviews and reviews of medical files of 24,000 puerperal women. “In total, we have visited 180 different cities and 266 different hospitals. Additionally, we have conducted a complementary interview over the telephone, 60 days after these women had given birth”, said Maria do Carmo.

In the interview below, the coordinator tells us about the importance of reducing the number of cesarean sections in Brazil to “reduce risks, recovery the naturality of birth, and optimize the contact of the mother and the baby in this very important moment of their lives and the lives of family members.”

When and how was the project created?

The idea for the project came from the concern of some researchers about the increasing rate of cesarean sections in Brazil and from reports in the scientific literature of the harms this intervention causes when performed unnecessarily. These researchers sought the Ministry of Health (DECIT), which then published a public notice to summon a research activity in national territory.

Which are the risks of a cesarean section in Brazil? What can be done to improve this surgical procedure?

The purpose of the project is to exactly answer that to Brazil. However, information available in the international literature mention the following harms to women: increased risk of death, infection, post-partum discomfort, mother breastfeeding impairment; and to subsequent pregnancies: low implantation of the placenta, placenta accrete, uterine rupture. To new-born babies: increased risks of prematurity, need for ventilation support for breathing when born, use of neonatal ITU, less contact with the mother immediately after birth.

What is the importance of this project to society?

First, to consider birth as a social, cultural and family process of human reproduction, in which women play the leading role, not the healthcare professional. Childbirth belongs to women, and shall not be a medical act, as it is not in European countries, although the majority occurs within health assistance services. The role of the healthcare professional is helping and supporting, but women are in charge of the childbirth and may choose how it will happen: squatting, on water, seated, etc. However, it is important not to mix freedom of choice for the type of childbirth with freedom of choice for undergoing a surgery or not. In European countries, the cesarean section is chosen based on a medical complication during pregnancy, not on an uninformed choice of women. Differently from Brazil, mothers are afraid when they have to undergo a cesarean section because they are aware of the risk of complications.

In 2010, this project was selected as one of the 15 most innovating projects in Public Health, in the category of Formulation, Implementation and Assessment of Policies. On your opinion, such recognition is a result of what aspects?

There are three aspects related to the project: its relevance, which occurred simultaneously to the launching of Rede Cegonha, a set of policies to change perinatal results in Brazil; the quality of study methodology that will manage to answer questions which are extremely important to the health of puerperal women and new-born babies; and the coincidence with the social movement of women that have been recently going to the streets, claiming for their rights to decide about their childbirth.

As a professional and citizen, how do you see your participation in the project?

I am the coordinator of this project and I have the cooperation of a central team, Fiocruz team, and teams from other Brazilian public institutions. I feel I am conducting an important study for decision making purposes on the part of the Ministry of Health concerning childbirth policies in the current scenario. I also feel I am conducting a basis study for the assessment of policies to be implemented some years ahead.