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Instituto Nacional de Salud Pública

2004, Number 1

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salud publica mex 2004; 46 (1)

Caesarean sections in Mexico: tendencies, levels and associated factors

Puentes-Rosas E, Gómez-Dantés O, Garrido-Latorre F

Language: Spanish
References: 29
Page: 16-22
PDF size: 112.52 Kb.


ABSTRACT

Objective. To describe the rate of caesarean sections in Mexico in the last 10 years and evaluate its relationship with several socioeconomic variables, type of health care services, and specialists’ availability. Material and Methods. The Ministry of Health’s register of births was used as source of information. The dependent variable was the type of delivery (vaginal or caesarean). The independent variables were: gross domestic product, human development index, illiteracy percentage among women, social exclusion index and, gynecology and obstetrics specialists supply. Correlations between variables were evaluated using Pearson’s parametric test and Spearman range test. A lineal multiple regression was used to model the national caesarean data of 1999. Results. National caesarean percentage increased in the last 10 years at an annual rate of 1%. It was considerably higher in social security institutions and the private sector. Caesareans percentages in 1999 were slightly above 35%. The highest values were those of the private sector with 53%, followed by social security institutions, with 38.2%. The variables more strongly associated with C sections were GDP, specialists’ availability and human development index. Conclusions. It seems reasonable to advocate for a widespread descent in caesarean sections in Mexico. Important declines in certain contexts have been witnessed by implementing measures such as a second opinion before any C-section, a precise definition of the reasons for using it, and the monitoring of individual caesarean percentage among hospital obstetricians.


REFERENCES

  1. World Health Organization. Appropriate technology for birth. Lancet 1985;2:436-437.

  2. Cerda H. Uno de cada cuatro niños nace por cesárea. El País 2001; octubre 30:28.

  3. Johanson R, Newburn M, Macfarlane A. Has the medicalisation of childbirth gone too far? BMJ 2002;324:892-895.

  4. Martin JA, Hamilton BE, Ventura SJ, Menacker F, Park MM. Births: Final data for 2000. Natl Vital Stat Rep 2002;(5):1-101.

  5. Belizán JM, Althabe F, Barros FC, Alexander S. Rates and implications of caesarean sections in Latin America: Ecological study. BMJ 1999;319:1397-1402.

  6. Murray SF. Relation between private health insurance and high rates of caesarean section in Chile: Qualitative and quantitative study. BMJ 2000;321:1501-1505.

  7. Amu O, Rajendran S, Bolaji I. Maternal choice alone should not determine method of delivery. BMJ 1998;317:462-465.

  8. Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. A sphincter disruption during vaginal delivery. N Engl J Med 1993;329:1905-1911.

  9. Al-Mufti R, McCarthy A, Fisk NM. Obstetricians´ personal choice and mode of delivery. Lancet 1996;347:544.

  10. De Costa C. A sort of progress. Lancet 1998;351:1202-1203.

  11. Payne D. Oreland sees big increase in caesarean sections. BMJ 2000;320:140.

  12. Kleinbaum D, Kupper L, Muller K. Applied regression analysis and other multivariable methods. Second edition, Belmont: Duxbury Press, 1988.

  13. Instituto Nacional de Estadística, Geografía e Informática. Sistema de Cuentas Nacionales. PIB por entidad federativa 1993-2000. Aguascalientes, México: INEGI, 2000.

  14. Consejo Nacional de Población. México en cifras. Disponible en: www.conapo.gob.mx/m_en_cifras/principal.html. Consultado el 15 de marzo de 2002.

  15. Velasco V, Navarrete E, Pozos JL, Ojeda RI, Cárdenas C, Cardona JA. Indicaciones y justificación de las cesáreas en el IMSS. Gac Med Mex 2000;136:421-431.

  16. Placek PJ, Taffel SM. Recent patterns in cesarean delivery in the United States. Obstet Gynecol 1985;28:735-744.

  17. Taffel SM, Placek PJ, Liss T. Trends in the United States cesarean section rate and reasons for the 1980-85 rise. Am J Public Health 1987;77:955-959.

  18. Flamm BL. Vaginal birth after cesarean section: Controversies old and new. C Obstet Gynecol 1985;28:735-744.

  19. Placek OJ, Taffel SM. Vaginal birth after cesarean section in the 1980. Am J Public Health 1988;78:512-515.

  20. Barros FC, Vaughan JP, Victora CG, Huttly RS. Epidemic of caesarean sections in Brazil. Lancet 1991;338:167-169.

  21. Béhague DP, Victora CG, Barros FC. Consumer demand for caesarean sections in Brazil: Population based birth cohort study linking ethnographic and epidemiological methods. BMJ 2002;324:942-945.

  22. Campero L, García C, Díaz C, Ortiz O, Reynoso S, Langer A. “Alone, I wouldn´t have known what to do”: A qualitative study on social support during labor and delivery in Mexico. Soc Sci Med 1998;47:395-403.

  23. Paterson-Brown S. Yes, as long as the woman is fully informed. BMJ 1998;317:462-465.

  24. Groopman J. A knife in the back. New Yorker 2002;April 8:66-73.

  25. Goyert G, Bottoms S, Treadwell M, Nehra P. The physician factor in caesarean birth rates. N Engl J Med 1989;320:706-709.

  26. Berkowitz GS, Fiarman GS, Mojica MA. The effect of physician characteristics on the caesarean birth rates. Am J Obstet Gynecol 1989;161:146-149.

  27. Guzmán S. La reducción de cesáreas de 28 a 13% incrementa o no la mortalidad materna y perinatal: la gran pregunta. Ginecol Obstet Mex 1993;66:122-125.

  28. Myers S, Gleicher N. A succesful program to lower caesarean section rates. N Engl J Med 1988;319:1511-1516.

  29. Flamm BL, Berwick DM, Kabcenell A. Reducing caesarean section rates safely: Lessons from a “breakthrough series” collaborative. Birth 1998;25(2):117-124.




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