Knowledge, attitudes and practices of Brazilian obstetricians in relation to childbirth care

To analyze the knowledge, attitudes, and practices of obstetricians regarding childbirth care.

This was a nationwide cross-sectional study involving 1267 physicians working in 393 public and private hospitals in Brazil. A self-administered and anonymous questionnaire, developed specifically for this study, was used. Differences in proportions among obstetricians working in public, mixed, and private services were analyzed using the chi-square test, with a significance level of 0.05.

High levels of knowledge, favorable attitudes, and adoption of best practices in childbirth care were observed for diet, movement, the presence of a companion, and non-pharmacological methods for pain relief. Limitations were identified regarding the participation of nurse-midwives in childbirth care, the use of instrumental delivery, promotion of upright birth positions, and the use of episiotomy. Fear of legal action and unnecessary indications for cesarean sections were frequently reported by professionals as reasons for the country's high cesarean section rates, and should be addressed in medical schools and specialization courses. A more positive perception of cesarean delivery as safe, and the defense of cesarean section as a woman's right, were more common in private services, where there was also less acceptance of births attended by nurse-midwives.

Differences observed between public and private services may inform the development of new strategies and strengthen ongoing initiatives in Brazil, with the aim of reducing cesarean section rates and promoting best practices in childbirth care.