Publication:

Obstetric factors associated with cesarean section: a retrospective study of 1,485 births in Southern Brazil

Background Cesarean rates have risen globally beyond recommended levels, without consistent improvements in maternal and neonatal outcomes. In Brazil, high rates persist despite policies promoting evidence-based, humanized care, with limited adherence in practice. This study aimed to identify factors associated with delivery mode in a hospital in southern Brazil to support vaginal birth and align practices with current recommendations.

Methods A retrospective, descriptive, cross-sectional quantitative study was conducted based on the analysis of 1,485 medical records of parturients assisted through the Brazilian Unified Health System (SUS) who underwent vaginal or cesarean delivery between 2019 and 2021, in a hospital institution in Rio Grande do Sul, Brazil. Maternal characteristics, clinical conditions, and obstetric practices were assessed. Logistic regression analysis was performed to estimate odds ratios (ORs) and identify variables associated with mode of delivery.

Results Among the 1,485 medical records of parturients, 47.9% had a vaginal birth and 52.1% underwent a cesarean section. Primiparity, absence of cervical dilation upon admission, absence of desire for vaginal delivery, non-performance of amniotomy, administration of oxytocin, as well as non-pharmacological measures were significantly associated with a greater likelihood of cesarean section. Primiparous women were more likely to undergo a cesarean section (OR=2.97), while advanced cervical dilation (7–10 cm) markedly reduced the odds of cesarean delivery (OR=0.03). Maternal preference for vaginal birth, amniotomy, and the use of non-pharmacological measures were also protective factors against cesarean section.

Conclusions In conclusion, cesarean delivery is influenced by modifiable clinical and care-related factors, highlighting opportunities to reduce unnecessary interventions. Promoting evidence-based, woman-centered practices may contribute to increasing vaginal birth rates and improving maternal and neonatal outcomes.