Results
There were 157 obstetricians working in the four large maternity hospitals and 114 answered our questionnaire. In the congresses, it was not possible to obtain information about the exact numbers of obstetricians enrolled, as other specialists such as urologists enrol as well, but the organizers did not have the information of enrolment by specialty. In any case, most were gynaecologists/obstetricians. One of us (ALSM), with the help of a research assistant, personally approached all participants who attended the three congresses. The number of physicians enrolled in the Rio de Janeiro congress in 2017 was 550 and we managed to approach 216. Of these, 212 answered the questionnaire; three refused to answer and one did not return it. In the Belém congress there were 207 physicians from Rio de Janeiro enrolled. Of these, we managed to approach 60, but 7 had already answered the questionnaire in the previous congress, three did not return the questionnaire and one refused to answer it. Finally, in the Rio de Janeiro congress in 2018 there were 459 physicians enrolled, but a large number had already answered our questionnaire in the previous congresses or in the hospitals. In this last wave of data collection 139 answered our questionnaire, with one refusal and no unreturned questionnaire. Thus, in total 465 obstetricians answered our questionnaire, with only five refusals and four unreturned questionnaires.
Most participants were female and younger than 50 years of age (mean age 42). Nearly a fifth was trainees and worked only in the private sector (Table 1).
The 72% preference for vaginal birth was similar within the demographic subgroups, except for practice sector: among obstetricians who practiced only in the public sector (131) and only in the private sector (85), the preference for vaginal birth was 80% (95%CI 73 - 86) and 60% (95%CI 49 - 70), respectively (Table 2).
The main reasons selected from a checklist for preferring vaginal birth were speedier recovery and lower risk of postpartum infection. Safety of the baby and the possibility to plan were the main reasons for preferring Caesarean. Safety of the baby was also one of the main reasons for preferring vaginal birth (Table 2).
The most prevalent actual mode of delivery was Caesarean, with 75% (95% CI 68 - 81) of the 181 obstetricians and 79% (95% CI 69 - 86) of the 81 obstetricians’ partners delivering the first child through this mode. Together, 76% (95% CI 71 - 81) of the 262 participants who delivered at least one child had Caesarean for the first child (Table 3).
Among the 200 participants who had a C-section for the first child, there was a medical reason / advice for the C-section in 73% (95% CI 66 - 79); within those who reported that they preferred a vaginal birth this prevalence was 88% (95% CI 81 - 93) while within those who preferred a C-section, this prevalence was 53% (95% CI 42 - 63). (Table 3).
Among the 170 participants who preferred vaginal birth for own child and delivered at least one child, 34% had a vaginal birth for the first child, while among the 90 participants who preferred Caesarean, 96% had a Caesarean for the first child (Table 3).