Caesarean sections and maternal mortality in Sao Paulo

To evaluate caesarean section in both public and private sectors; maternal mortality associated with mode of delivery in the public sector (Sistema Unico de Saude, SUS) in Sao Paulo State, Brazil.

610,630 births in both public and private sectors for 2003; 1,153,034 deliveries and 314 maternal deaths in the public sector for 2001-2003. The study estimated caesarean section rates and odds ratios for caesarean section in association with maternal characteristics in both public and private sectors; maternal mortality associated with mode of delivery in the public sector, adjusted for hypertension, other disorders, problems and complications, as well as maternal age.

The caesarean section rate was 32.9% in the public sector, and 80.4% in the private sector. The odd ratio for caesarean section was 2.6 (95% CI: 2.6-2.7) for women with 12 or more years of education. The odd ratio for maternal mortality associated with caesarean section in the public sector was 3.3 (95% CI: 2.6-4.3).

Sao Paulo presented high caesarean section rates. Caesarean section compared to vaginal delivery in the public sector presented higher risk for mortality even when adjusted for hypertension, other disorders, problems and complications, as well as maternal age.