And Brazil's alarming rate

October 2021, study conducted by Trocando Fraldas with more than 5,000 women between October 11 and 19, 2021: The birth of a baby can occur in two ways, either through vaginal birth or cesarean section. In a vaginal birth, which is considered the only natural way to give birth, the baby is born through the vaginal canal. In a cesarean birth, which is a surgery, the obstetrician makes an incision in the abdominal area for the baby's delivery.

As found in our most recent study, 32% of Brazilian women prefer cesarean birth. This is especially true for women over 35 years old, with 48% among those interviewed. In addition, women who already have children are more likely to prefer a cesarean, 37%, compared to those who don't have children yet, 24%.

Which type of birth do you prefer?

Benefits of vaginal birth

Vaginal birth is demanding for mothers, and when the time comes, anxiety takes over. Because of this, 56% reported being or having been afraid of vaginal birth. Especially among participants aged 18 to 24 years old, with 59% of them. For women aged 25 to 29, this fear drops a bit, and 45% did not or do not feel afraid.

Vaginal birth is recommended in all cases where there is no risk to the mother or the baby. Besides, it offers more benefits to both: it usually requires only 1 to 2 days of hospitalization, recovery is faster, there is less postpartum pain, and it does not leave scars.

Are you or have you been afraid of vaginal birth?

  • Roraima is the state where the most women are afraid of vaginal birth, with 82% of respondents.
  • In Espírito Santo and Rio de Janeiro, the percentage of participants who are afraid is 61% and 60%, respectively.
  • In São Paulo and the Federal District, the percentage drops to 53%. In Sergipe, it is 45%, the lowest among states.

High cesarean rates in Brazil

Cesarean sections, when truly necessary, can save the lives of both mother and baby. However, when recommended to women who could deliver vaginally, it brings unnecessary health risks for both mother and baby: increasing the likelihood of breathing problems in the newborn by 120 times and tripling the risk of maternal death, according to data from ANS – National Supplementary Health Agency.

Many doctors, especially those in private practice or working with health plans, often try to convince mothers to choose a cesarean. For them, it is easier, more convenient, and more profitable. After all, cesarean births have an extra cost and are generally not included in health insurance plans.

For this reason, and according to the ANS, the rate of unnecessary cesareans in Brazil's supplementary health system is currently 84.6% of births. The percentage recommended by the WHO – World Health Organization, is 10% to 15%.

Informed choice

The ANS has carried out, for more than a decade, continuous work to promote vaginal birth and reduce the number of unnecessary cesarean sections in supplementary health care. According to them, the decision about which type of birth is most appropriate needs to be shared between the doctor, the pregnant woman, and her family. The professional should give information about the woman's clinical situation and the risks and benefits involved in each option to help her make a decision. They should also guide the expectant mother without influencing her, sharing the responsibility on this matter.

However, our study also found that 18% of Brazilian women had or have a cesarean scheduled before completing 39 weeks of pregnancy. Especially among women aged 35 to 39, with 30% of respondents.

  • Goiás is the state where the most women had a cesarean scheduled before 39 weeks, with 31% of respondents.
  • In São Paulo and Minas Gerais, 18% had a cesarean scheduled. In Rio de Janeiro, the rate is 17%.
  • Amapá has the lowest percentage of scheduled cesarean sections before 39 weeks, with 5% of the population.

Ranking of states where Brazilian women have or had a cesarean scheduled before completing 39 weeks of pregnancy

  • 1.Goiás
  • 2.Rondônia
  • 3.Piauí
  • 4.Rio Grande do Sul
  • 5.Espírito Santo
  • 6.Ceará
  • 7.Mato Grosso
  • 8.Santa Catarina
  • 9.Acre
  • 10.São Paulo
  • 11.Pará
  • 12.Minas Gerais
  • 13.Rio de Janeiro
  • 14.Amazonas
  • 15.Paraná
  • 16.Bahia
  • 17.Maranhão
  • 18.Mato Grosso do Sul
  • 19.Pernambuco
  • 20.Rio Grande do Norte
  • 21.Alagoas
  • 22.Roraima
  • 23.Paraíba
  • 24.Federal District
  • 25.Sergipe
  • 26.Tocantins
  • 27.Amapá

Thinking about ensuring that women have access to all the necessary information to decide on the type of birth, ANS created Normative Resolution No. 368. Women of childbearing age, pregnant women, health professionals, and health plan operators need to be aware of the rules that ensure more care and safety for mothers at birth.

Percentage of Brazilian women who prefer vaginal birth, by state (h3)

Research Method

The study covered the entire country and was conducted with more than 5,000 women between October 11 and 19, 2021. The data collection method was through an online questionnaire.

The following questions were addressed:

  • Which type of birth do you prefer?
  • Are you or have you been afraid of vaginal birth?
  • Have you had or do you have a cesarean scheduled before completing 39 weeks of pregnancy?

For comparison between regions and states, answers to yes/no questions were counted numerically, 1 for "yes" and 0 for "no". Some questions, in order to obtain more qualitative results, were designed with more options.