Open Access Study protocol

Birth in Brazil: national survey into labour and birth

Maria do Carmo Leal113*, Antônio Augusto Moura da Silva2, Marcos Augusto Bastos Dias3, Silvana Granado Nogueira da Gama1, Daphne Rattner4, Maria Elizabeth Moreira3, Mariza Miranda Theme Filha1, RosaMariaSoaresMadeira Domingues1, Ana Paula Esteves Pereira1, Jacqueline Alves Torres5, Sonia Duarte Azevedo Bittencourt1, Eleonora D’orsi6, Antonio JLA Cunha7, Alvaro Jorge Madeiro Leite8, Rejane Silva Cavalcante9, Sonia Lansky10, Carmem Simone Grilo Diniz11 and Célia Landmann Szwarcwald12

Author Affiliations

1 Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil

2 Universidade Federal do Maranhão, Maranhão, Brazil

3 Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil

4 Universidade Nacional de Brasília, Brasília, Brasil

5 Agência Nacional de Saúde Suplementar, Rio de Janeiro, Brazil

6 Universidade Federal de Santa Catarina, Santa Catarina, Brazil

7 Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

8 Universidade Federal do Ceará, Ceará, Brazil

9 Universidade Federal do Pará, Pará, Brazil

10 Secretaria Municipal de Saúde de Belo Horizonte, Belo Horizonte, Brazil

11 Universidade de São Paulo, São Paulo, Brazil

12 Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil

13 Escola Nacional de Saúde Pública Sergio Arouca, Rua Leopoldo Bulhões, 1480, sala 809 - Manguinhos, Rio de Janeiro, RJ, Brazil, CEP: 21041-210

For all author emails, please log on.

Reproductive Health 2012, 9:15  doi:10.1186/1742-4755-9-15

Published: 22 August 2012



Caesarean section rates in Brazil have been steadily increasing. In 2009, for the first time, the number of children born by this type of procedure was greater than the number of vaginal births. Caesarean section is associated with a series of adverse effects on the women and newborn, and recent evidence suggests that the increasing rates of prematurity and low birth weight in Brazil are associated to the increasing rates of Caesarean section and labour induction.


Nationwide hospital-based cohort study of postnatal women and their offspring with follow-up at 45 to 60 days after birth. The sample was stratified by geographic macro-region, type of the municipality and by type of hospital governance. The number of postnatal women sampled was 23,940, distributed in 191 municipalities throughout Brazil. Two electronic questionnaires were applied to the postnatal women, one baseline face-to-face and one follow-up telephone interview. Two other questionnaires were filled with information on patients’ medical records and to assess hospital facilities. The primary outcome was the percentage of Caesarean sections (total, elective and according to Robson’s groups). Secondary outcomes were: post-partum pain; breastfeeding initiation; severe/near miss maternal morbidity; reasons for maternal mortality; prematurity; low birth weight; use of oxygen use after birth and mechanical ventilation; admission to neonatal ICU; stillbirths; neonatal mortality; readmission in hospital; use of surfactant; asphyxia; severe/near miss neonatal morbidity. The association between variables were investigated using bivariate, stratified and multivariate model analyses. Statistical tests were applied according to data distribution and homogeneity of variances of groups to be compared. All analyses were taken into consideration for the complex sample design.


This study, for the first time, depicts a national panorama of labour and birth outcomes in Brazil. Regardless of the socioeconomic level, demand for Caesarean section appears to be based on the belief that the quality of obstetric care is closely associated to the technology used in labour and birth. Within this context, it was justified to conduct a nationwide study to understand the reasons that lead pregnant women to submit to Caesarean sections and to verify any association between this type of birth and it’s consequences on postnatal health.

Caesarean section; Elective Caesarean section; Robson’s groups; Near miss maternal morbidity; Near miss neonatal morbidity; Prematurity; Low birth weight; Brazil