Incidence of cesarean section regarding the financial support source for delivery care

OBJECTIVE: To study the types of delivery according to the category of patient admission and the most frequently reported indications for cesarean sections. METHODS: In a retrospective survey of deliveries performed in the municipality of Ribeir?o Preto, S?o Paulo, Brazil, from 1986 to 1995, the type of delivery, category of admission and recorded diagnoses were assessed. Data were obtained from the Center of Hospital Data Processing of the Department of Social Medicine in the University of S?o Paulo, Ribeir?o Preto. RESULTS: A total of 86,120 deliveries were registered during the study period; 5.4% were allocated in the private category, 28.7% in the prepayment category, and 65.9% in the public health system (SUS). It was observed a decrease in the private and SUS categories and an increase in the prepayment category. During the study period, the percentage of cesarean deliveries increased from 68.3% to 81.8% in the private category and from 69.1% to 77.9% in the prepayment category, and decreased from 38.7% to 32.1% in the SUS category. The major indications for cesarean section were fetal distress, with the incidence of 9.5%, 10.9% and 9.0% in the private, prepayment and SUS categories, respectively; and cephalopelvic dystocia, at the rates of 5.8%, 6.5% and 3.9%, respectively. CONCLUSION: The incidence of cesarean section varied according to admission category, with a rising trend as the pregnant woman's social status increased, but without a correlation with the obstetrical risk.