Cesarean sections: risk perception and indication by attending obstetricians in a public maternity hospital in Rio de Janeiro

A taxa de cesariana entre as maternidades p??blicas municipais da cidade do Rio de Janeiro no ano de 2000 foi de 30,1%. Com taxas t??o elevadas, nossas hip??teses s??o que as indica????es de cesarianas nestas unidades n??o est??o restritas apenas ??s indica????es cl??nicas. Este artigo tem como objetivo analisar as representa????es de m??dicos sobre os riscos inerentes da cesariana que influenciam a sua indica????o. Neste estudo qualitativo, realizado com observa????o participante de plant??es e entrevistas com obstetras, pudemos identificar que as indica????es feitas pelos obstetras da unidade p??blica estudada sofrem influ??ncia de diversos fatores n??o obst??tricos: a inseguran??a quanto ??s manobras obst??tricas, a fragmenta????o do atendimento e o medo da responsabiliza????o jur??dica, entre outros. O artigo sugere que a banaliza????o desta interven????o no servi??o privado traz para o servi??o p??blico um desvio da pr??tica obst??trica que compromete n??o apenas a qualidade da assist??ncia p??blica, como pode colocar em risco a vida de mulheres e beb??s.The cesarean section rate in municipal public maternity hospitals in the city of Rio de Janeiro in the year of 2000 was 30.1%. With such a high rate, our hypothesis is that attending obstetricians in these units are indicating cesarean sections for reasons not restricted to clinical factors. The article aims to analyze physicians' representations of the inherent risks in cesarean sections that influence the medical decision for their indication. In this qualitative study, conducted through participant observation during ward duty and interviews with obstetricians, we observed that C-section indications by obstetricians are influenced by various non-obstetric factors, including insecurity about performing obstetric maneuvers, fragmented care, and fear of legal liability. The paper suggests that the widespread use of this intervention in private maternity services has fostered a practice in public obstetric services that compromises the quality of public health care and may jeopardize the health of women and infants