03/21/2023
Table with surgical instruments
A national policy that established a minimum gestation period for elective C-sections and determined that the parturient be informed about the risks of the procedure managed to reduce surgical deliveries by 3%. The newborns’ weight, gestation period and well-being indicator also improved slightly.
In June 2016, new rules defined by the Brazilian Federal Council of Medicine became effective throughout the country, aiming to reduce the high incidence of C-section deliveries in Brazil. On the one hand, they specified 39 weeks as the minimum gestation period to perform the elective procedure — when the method is an option for the mother, with no clinical indication for surgery.
On the other hand, the regulation has made health services provide detailed information on the risks and benefits of the types of delivery methods for pregnant women who initially opt for a C-section after the minimum period.
The introduction of the new protocols was used by Insper researchers Carolina Melo and Naercio Menezes Filho as a benchmark to compare the situation of C-section deliveries before and after the change.
As the cases with medical indication for a surgical procedure were not impacted by the measure, a significant number of them — when babies are not in a cephalic position favorable to vaginal delivery — were used in the study as a contrast to detect changes in patterns in voluntary C-sections.
The incidence of elective C-sections in which the baby was in a favorable position for vaginal delivery began to show a decreasing and divergent trend from the pattern prior to the changes. The econometric analysis estimated that the proportion of C-sections dropped from 55% to 53.4% of total births in the country after introduction of the new protocols.
While looking into the result, the researchers noticed that the effect of the reduction was concentrated in women who, already in labor, opted for the vaginal method, which indicated that the instructions they received about the risks and benefits of the procedures at their disposal were the decisive factor for the end result. Women who were not giving birth for the first time, treated at public hospitals of the national health system (SUS) were the ones who most reduced C-sections, according to the study.
The policy has also slightly increased the average birth weight (10 grams), the duration of gestation (1 day) and also the Apgar indicator (0.03 point on a scale from 0 to 10), which assesses the well-being of the newborn in the first minute of life.