Using the Robson 10-Group Classification System to Compare Cesarean Birth Utilization Between US Centers With and Without Midwives.

INTRODUCTION: The Robson 10-group classification system stratifies cesarean birth rates using maternal characteristics. Our aim was to compare cesarean birth utilization in US centers with and without midwifery care using the Robson classification. METHODS: We used National Institute of Child and Human Development Consortium on Safe Labor data from 2002 to 2008. Births to women in centers with interprofessional care that included midwives (n = 48,857) were compared with births in non-interprofessional centers (n = 47,935). To compare cesarean utilization, births were classified into the Robson categories. Cesarean birth rates within each category and the contribution to the overall rate were calculated. Maternal demographics, labor and birth outcomes, and neonatal outcomes were described. Logistic regression was used to adjust for maternal comorbidities. RESULTS: Women were less likely to have a cesarean birth (26.1% vs 33.5%, P < .001) in centers with interprofessional care. Nulliparous women with singleton, cephalic, term fetuses (category 2) were less likely to have labor induced (11.1% vs 23.4%, P < .001), and women with a prior uterine scar (category 5) had lower cesarean birth rates (73.8% vs 85.1%, P < .001) in centers with midwives. In centers without midwives, nulliparous women with singleton, cephalic, term fetuses with induction of labor (category 2a) were less likely to have a cesarean birth compared with those in interprofessional care centers in unadjusted comparison (30.3% vs 35.8%, P < .001), but this was reversed after adjustment for maternal comorbidities (adjusted odds ratio, 1.21; 95% CI, 1.12-1.32; P < .001). Cesarean birth rates among women at risk for complications (eg, breech) were similar between groups. DISCUSSION: Interprofessional care teams were associated with lower rates of labor induction and overall cesarean utilization as well as higher rates of vaginal birth after cesarean. There was consistency in cesarean rates among women with higher risk for complications.

Nascer em Belo Horizonte: processo decisório e fatores obstétricos associados à via de nascimento / Birth in Belo Horizonte: decision-making process and obsttric factors associated with the way of birth

Introdução: Atualmente, o modelo de atenção ao parto no Brasil caracteriza-se por altos índices de intervenções desnecessárias, dentre elas, as cesarianas realizadas sem indicações clínicas. Neste contexto, as possíveis causas do aumento da proporção de cesarianas têm sido cada vez mais discutidas. Objetivo: analisar o processo decisório de gestantes pela via de nascimento e estimar a associação entre os fatores obstétricos e a via de nascimento em Belo Horizonte/Minas Gerais, Brasil. Método: Trata-se de estudo transversal, realizado em sete maternidades públicas e quatro maternidades que atendem a Rede Suplementar de Saúde em Belo Horizonte, no período de 2011-2013. A diferença entre as frequências foi testada por meio do Qui-quadrado de Pearson e do Teste exato de Fisher. Para avaliar a associação entre os fatores obstétricos e a via de nascimento foram construídos modelos de regressão de Poisson. Utilizou-se o programa estatístico Stata, versão 14.0. Resultados: Nas maternidades públicas a amostra de 622 puérperas foi constituída predominantemente de mulheres com idade entre 20 e 34 anos (70,69%), pardas, morenas ou mulatas (66,16%), com ensino médio (56,88%), vivem com o companheiro (66,31%) e sem trabalho remunerado (55,60%). A principal intercorrência apresentada por elas na gravidez foi síndromes hipertensivas (11,60%). Das mulheres submetidas à cesariana, 46,03% entrou em trabalho de parto e, para 64,71% dos casos, a decisão foi médica. Em relação à rede suplementar de saúde,a amostra de 353 puérperas foi constituída predominantemente de mulheres com idade entre20 e 34 anos (73,33%), cor da pele parda, morena ou mulata(55,36%), com ensino médio (51,01%), viviam com o companheiro (88,41%) e com trabalho remunerado (73.33%). A principal intercorrência apresentada por elas na gravidez foi síndromes hipertensivas (8,52%). Das mulheres submetidas à cesariana, 20,78% entrou em trabalho de parto e, para 39,24% dos...

Introduction: At present, childbirth model care in Brazil is characterized by high rates of unnecessary interventions, such as cesarean sections performed without clinical indications. In this context, possible causes of the increase in proportion of cesareans have been increasingly discussed. Objective: to analyze the decision-making process of pregnant women through birth and estimate the association between obstetric factors and birthway in Belo Horizonte / Minas Gerais, Brazil. Method:This is a cross-sectional study arried out in seven public maternity hospitals and four maternity hospitals that serves Supplementary Health Network in Belo Horizonte, in a period 2011-2013. The difference between the frequencies was tested using Pearson's Chi-square and the Fisher's exact test. Poisson regression models were constructed to assess the association between obstetric factors and birthway. The statistical program Stata, version 14.0 was used. Results: In public maternity hospitals, the sample of 622 postpartum women consisted predominantly of women aged between twenty and 34 years (70.69%), browns, brunettes or mulattoes (66.16%), with a high school education (56.88%), live with their partner (66.31%) and without paidwork (55.60%). The main intercurrence presented by them during pregnancy was hypertensive syndromes (11.60%). Of the women submitted to cesarean section, 46.03% went into labor and 64.71% of the cases, decision was a...