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Women Birth. 2017 Dec 8. pii: S1871-5192(17)30325-6. doi: 10.1016/j.wombi.2017.11.011. [Epub ahead of print]

How obstetricians and pregnant women decide mode of birth in light of a recent regulation in Brazil.

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Yale University, New Haven, CT, USA. Electronic address:
Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.
Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, RS, Brazil.
Department of Maternal and Child Health, Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, RS, Brazil.



In Brazil, 88% of births among women with private insurance are caesarean sections, even though a caesarean rate above 15% is associated with greater maternal and child morbidity and mortality. Aiming to reduce unnecessary caesarean sections in the private sector, in July 2015 the Brazilian government enacted Resolução Normativa 368, a regulation requiring the use of partograms, pre-natal cards to document pregnancies, and consent forms for elective caesareans, and recommending that obstetricians provide women with an informational letter about birth.


This study aimed to describe Brazilian women's experiences deciding their mode of birth and obstetricians' roles in this decision-making process after Resolução Normativa 368's enactment.


Interviews were conducted with obstetricians (n=8) and women who had recently given birth (n=19) in Pelotas, Brazil, and the constant comparative method was used to identify emergent themes.


Resolução Normativa 368's provisions do not appear to affect decision-making about birth mode. Reportedly, consent forms were rarely used, and were viewed as bureaucratic formalities. Obstetricians described consistent use of pre-natal cards and partograms, but all participants were unaware of informational letters about birth. Moreover, women viewed caesarean sections as a way to avoid pain, and obstetricians felt that vaginal birth's long duration, unpredictability, and low remuneration contribute to high caesarean section rates.


Improved enforcement of Resolução Normativa 368, accompanied by structural changes like an on-call schedule and higher compensation for vaginal births in the private sector, could better inform patients about modes of birth and incentivise physicians to encourage vaginal birth.


Brazil; Caesarean birth; Obstetrics; Pregnancy; Vaginal birth

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