Normal birth vs. cesarean: preferences of two groups of women in the Family Health Strategy

Resumo

As childbirth is a significant event for women, this study aimed to know the preference and the factors that determine the choice of mode of delivery, considering normal and caesarean section, of two groups: primiparous and multiparous women. This is an exploratory and descriptive field survey with quantitative and qualitative approach. After approval by the Ethics Committee (Opinion nº 206.863/2013), the study was conducted in two health units of the municipality of Sinop-MT, in the period from April to June 2013, with two groups of women. The participants were 27 women; 15 (55.56%) primiparous and 12 (44.44%) multiparous women. The latter had experienced normal and cesarean birth.  Primiparous women were younger (18-30 years) than multiparous, 40% had a family income of one minimum wage and 60% were common-law married. Multiparous women were older (25-61 years), many had not completed high school (58.33%), were married (58.33%) and had family income above one minimum wage. The median age of menarche in both groups of women was 12 years and the first sexual relationship of the primiparous occurred at younger age (16 years) than the multiparous (17 years). Among primiparous women, 33.33% (n: 5) had begun prenatal at eight weeks of pregnancy and 73.33% (n: 11) had attended five or more prenatal consultations. Among multiparous women, 83.33% (n: 10) had received prenatal care in all pregnancies, only seven women had more than six consultations, and these two groups were assisted by medical and nursing professionals. As for questions and information about pregnancy, women sought people close to them such as mothers, mothers-in-law, female friends, besides doctors, internet and few women sought nurses. The majority (n: 15) of women did not receive guidance on the signs of childbirth and the types of delivery. Among the women who received such information, this came from doctors or nursing teams. Regarding the time of hospitalization of the multiparous women, they were hospitalized for one day when they went through normal delivery and two days when they went through cesarean delivery. With regard to breastfeeding, children of multiparous women were breastfed within one hour after normal delivery and cesarean section, and 62.5% (n: 10) continued breast-feeding for more than six months. When asked about the type of delivery they wanted to have, 86.67% (n: 13) of primiparous women responded vaginal delivery. Among multiparous women, 58.5% (n: 24) chose normal delivery route for their pregnancies. Among deliveries (n: 12) of primiparous women, 58.33% had caesarean and 41.67% had normal deliveries, and among multiparous, there were 61% normal deliveries and 39% caesarean sections. On the incidence of births in the municipality from January to June 2013, there were 66.51% normal deliveries and 33.49% caesarean sections. Regarding the sensation of pain during childbirth between multiparous women, 58.33% said they felt more pain before and during vaginal delivery and 33.33% said after cesarean section. They described the pain of normal childbirth as a unique and difficult to explain, a painful experience, however, satisfactory after the birth of the child. The reasons cited by multiparous women for the preferring vaginal delivery were faster recovery and return to normal activities, and the absence of pain after vaginal delivery. It is concluded that caesarean section rates remain high despite the fact that there is a preference for normal delivery. It is observed that more nursing instructions are necessary during prenatal care.

Key-words: Nursing. Pregnancy. Childbirth.