Cesarean section prevalence at a baby-friendly hospital in southern Brazil: current context in the face of COVID-19

Objective To analyze cesarean prevalence at a baby-friendly hospital in Southern Brazil between 2017 and 2020 and possible annual and monthly changes due to the novel coronavirus (COVID-19) pandemic. Methods Descriptive cross-sectional study using secondary data retrieved from the electronic information system of a Baby-Friendly Hospital in the municipality of Rio Grande, RS, Brazil. Data was retrieved for all hospitalizations at the obstetric center between January 1 st 2017 and December 31 st 2020. Data on COVID-19 deaths were obtained from the municipal government website. Annual and monthly cesarean prevalence rates were calculated in comparison to the same periods in 2017, 2018 and 2019. Differences in prevalence rates were tested using a chi-square test, taking a significance level of less than 5%. Prevalence ratios were estimated for 2018/2017, 2019/2018, and 2020/2019. Results 7,294 childbirths were included. Cesarean prevalence was 42.6% in 2017, 44.3% in 2018, 40.2% in 2019, and 51.0% in 2020. In 2018/2017, there was no statistically significant difference in cesarean prevalence (95%CI: 0.90-1.20). Between 2019/2018, there was a reduction of approximately 20% in prevalence (95%CI: 0.69-0.93). The scenario changes between 2020/2019 with a 40% increase in cesareans (95%CI: 1.20-1.62). The period comprising July to December 2020 was the only period in which over half the deliveries were done by cesarean section, exceeding 60% in July. Conclusion Cesarean prevalence rates increased in 2020 in relation to the three preceding years. The data highlight the need to reinforce compliance with childbirth protocols to reduce cesarean sections in baby-friendly hospitals.