The increasing rates of cesarean sections (CS) in places with adequate access to health care is a global concern because they are related to higher rates of maternal and neonatal complications and do not provide a positive childbirth experience for women. The objective is to highlight the possibility of achieving CS rates acceptable by WHO standards, like Nordic countries, following evidence-based protocols in Brazil.
A cross-sectional study evaluated CS rates by Robson Groups for women who sought vaginal delivery in a private health practice in Brazil, comparing the rates with Swedish data. A collaborative practice with midwives and obstetrician, adopting evidence-based guidelines, was offered. The overall CS rate, CS rate by Robson group, contribution of each Robson group to the overall CS rate, clinical and non-clinical interventions and vaginal birth, pre-labor CS and intrapartum CS proportions were estimated. The expected CS rate for the population by the WHO c-model tool was calculated. The analysis used Microsoft EXCEL and the software "R Studio" (version 1.2.1335. 2009-2019).
The overall CS rate was 15.1% (within the expected by the WHO c-model tool) in a population composed of 43.7% of women in Robson Group 1, 11.4% in Group 2 and 14.9% in Group 5, the greatest responsible for higher rates of CS, who altogether contributed to 75.4% of all cesarean sections.
Multidisciplinary care following evidence-based protocols, associated to a high motivation of both women and professionals of childbirth care for a vaginal route for delivery may lead to a significant and safe reduction of CS rates, obtaining better results even in contexts such as Brazil, where there is high medicalization of obstetric care and excess of CS.