How obstetricians and pregnant women decide mode of birth in light of a recent regulation in Brazil.

BACKGROUND: In Brazil, 88% of births among women with private insurance are caesarean sections, even though a caesarean rate above 15% is associated with greater maternal and child morbidity and mortality. Aiming to reduce unnecessary caesarean sections in the private sector, in July 2015 the Brazilian government enacted Resolução Normativa 368, a regulation requiring the use of partograms, pre-natal cards to document pregnancies, and consent forms for elective caesareans, and recommending that obstetricians provide women with an informational letter about birth.

AIMS: This study aimed to describe Brazilian women's experiences deciding their mode of birth and obstetricians' roles in this decision-making process after Resolução Normativa 368's enactment.

METHODS: Interviews were conducted with obstetricians (n=8) and women who had recently given birth (n=19) in Pelotas, Brazil, and the constant comparative method was used to identify emergent themes.

FINDINGS: Resolução Normativa 368's provisions do not appear to affect decision-making about birth mode. Reportedly, consent forms were rarely used, and were viewed as bureaucratic formalities. Obstetricians described consistent use of pre-natal cards and partograms, but all participants were unaware of informational letters about birth. Moreover, women viewed caesarean sections as a way to avoid pain, and obstetricians felt that vaginal birth's long duration, unpredictability, and low remuneration contribute to high caesarean section rates.

CONCLUSIONS: Improved enforcement of Resolução Normativa 368, accompanied by structural changes like an on-call schedule and higher compensation for vaginal births in the private sector, could better inform patients about modes of birth and incentivise physicians to encourage vaginal birth.