Researchers surveyed over 1,200 doctors across Brazil to understand what they know and believe about childbirth care. They found that most doctors support good practices like letting mothers eat, move around, have a support person present, and use natural pain relief methods. However, the study revealed problems: doctors don’t always work with midwives, they perform too many cesarean sections, and they don’t encourage upright positions during birth. Doctors in private hospitals were more likely to recommend cesarean sections, partly because they worry about being sued. The findings suggest that medical schools need to teach doctors more about safe, natural birth options.

The Quick Take

  • What they studied: What do Brazilian doctors know, believe, and actually do when helping women give birth? Do they support natural birth methods or do they prefer surgical delivery?
  • Who participated: 1,267 obstetricians (pregnancy and birth doctors) working in 393 hospitals across Brazil—both public hospitals (government-run) and private hospitals (for-profit). All doctors answered an anonymous survey.
  • Key finding: Most doctors support good birth practices like allowing mothers to eat, move, have someone with them, and use natural pain relief. However, many doctors perform too many cesarean sections and don’t encourage midwives to help with births. Doctors in private hospitals were significantly more likely to recommend cesarean sections.
  • What it means for you: If you’re having a baby in Brazil, knowing what your doctor believes about birth can help you make better choices. You might want to ask your doctor about natural birth options, having a support person present, and whether a midwife can help. Be aware that private hospitals may push cesarean sections more than public hospitals.

The Research Details

This study used a cross-sectional design, which means researchers took a snapshot in time by asking all the doctors the same questions at roughly the same time. They created a custom questionnaire (survey) specifically for this research and sent it to obstetricians working in both public and private hospitals throughout Brazil. The survey was anonymous, so doctors could answer honestly without worrying about being identified. Researchers then compared the answers from doctors in public hospitals versus private hospitals to see if their beliefs and practices were different. They used statistical tests to determine if the differences were real or just due to chance.

Understanding what doctors actually think and do is important because their beliefs directly affect how they treat pregnant women. If doctors believe cesarean sections are safer or better, they’ll recommend them more often—even when vaginal birth might be just as safe. By surveying many doctors across the whole country, researchers could see patterns that show which practices need improvement. This type of study helps identify where medical education needs to change.

This study is reliable because it included a large number of doctors (1,267) from many different hospitals across an entire country, which makes the findings representative of Brazilian obstetrics. The anonymous survey format likely encouraged honest answers. However, the study only shows what doctors said they do, not what they actually do in real situations. Also, we don’t know how many doctors were invited but didn’t respond, which could affect the results if certain types of doctors were less likely to participate.

What the Results Show

The research found that Brazilian obstetricians generally support several evidence-based birth practices. Most doctors agreed that pregnant women should be allowed to eat and drink during labor, move around freely, have a companion present for support, and use non-drug pain relief methods like massage, position changes, and breathing techniques. These findings are encouraging because they align with what medical research shows is safe and beneficial.

However, significant problems were identified in other areas. Many doctors don’t involve nurse-midwives in childbirth care, even though midwives are trained specialists in normal birth. Doctors also don’t frequently encourage women to give birth in upright positions (sitting, squatting, or standing), which research shows can reduce pain and complications. Additionally, the use of episiotomy (cutting the perineum) was more common than current guidelines recommend.

The most striking finding was about cesarean sections. Doctors reported that fear of lawsuits and unnecessary medical reasons were major factors driving Brazil’s high cesarean section rate. Doctors in private hospitals were significantly more likely to view cesarean delivery as safe and to support it as a woman’s choice, compared to doctors in public hospitals. This difference between public and private hospitals suggests that financial incentives and legal concerns, rather than medical necessity, may be influencing delivery method decisions.

The study revealed important differences between public and private hospital settings. Private hospitals showed less acceptance of nurse-midwives participating in childbirth care and more defensive attitudes about cesarean sections. Public hospitals appeared more supportive of natural birth practices and midwife involvement. These differences suggest that the type of hospital where a woman gives birth may significantly influence the kind of care she receives. The research also highlighted that doctors’ concerns about legal liability are a major barrier to promoting vaginal birth, indicating that legal and professional culture issues need to be addressed alongside medical education.

This research aligns with international findings showing that private healthcare systems tend to have higher cesarean section rates than public systems. The study confirms what other research has suggested: that doctors’ attitudes and fears about lawsuits, rather than medical necessity, drive unnecessary cesarean sections. The positive finding about support for natural pain relief methods and companion support reflects a global trend toward more woman-centered birth practices. However, the finding that midwives aren’t fully integrated into Brazilian obstetric care contrasts with countries like the Netherlands and New Zealand, where midwives lead most normal births.

This study has several important limitations. First, it only shows what doctors said they believe and do, not what actually happens in real births—doctors might report supporting natural birth but practice differently. Second, we don’t know how many doctors refused to participate, and doctors who care more about birth practices might have been more likely to respond, skewing the results. Third, the study is a snapshot from one point in time and doesn’t show whether attitudes are changing. Finally, the study doesn’t explain why doctors hold certain beliefs or what would actually change their practices, so it identifies problems but doesn’t fully explain their causes.

The Bottom Line

Based on this research, medical schools and doctor training programs in Brazil should: (1) Teach doctors about the safety and benefits of natural birth practices and midwife involvement—confidence level: HIGH, supported by international evidence; (2) Address doctors’ legal concerns through better malpractice insurance and legal education rather than encouraging unnecessary cesarean sections—confidence level: MODERATE, based on doctors’ own reports; (3) Establish guidelines that discourage routine episiotomy and encourage upright birth positions—confidence level: HIGH, supported by research evidence; (4) Create incentive structures in private hospitals that reward vaginal birth when medically appropriate—confidence level: MODERATE, based on observed differences between hospital types.

Pregnant women in Brazil should care about these findings because they affect the birth care they’ll receive. Women who want to try natural birth should know that their doctor’s beliefs matter and should ask questions about their doctor’s approach. Healthcare policymakers and medical school administrators should use these findings to improve training and hospital policies. Midwives and nurse-midwives should care because the research shows they’re underutilized. Women’s health advocates should care because high unnecessary cesarean rates affect maternal health. However, women with high-risk pregnancies should follow their doctor’s recommendations for cesarean delivery when medically necessary—this research doesn’t suggest avoiding cesarean sections when truly needed.

Changes from this research will take time. Medical schools can update curricula within 1-2 years, but changing doctors’ deeply held beliefs and practices typically takes 5-10 years as new graduates enter the workforce. Hospital policy changes might happen faster (1-3 years) if administrators prioritize them. Individual women might see changes in their own care within months if they actively discuss birth preferences with their doctors. Significant reduction in unnecessary cesarean sections across Brazil would likely take 10+ years and require coordinated efforts in medical education, legal reform, and hospital incentive structures.

Want to Apply This Research?

  • Track your birth preferences and doctor communication: Log which natural birth practices your doctor supports (eating/drinking, movement, companion presence, natural pain relief, upright positions) and which ones they discourage. Rate your comfort level with your doctor’s approach on a 1-10 scale. This helps you identify whether your doctor aligns with your birth preferences before labor begins.
  • Have a specific conversation with your obstetrician about birth preferences. Use the app to create a birth plan checklist covering: (1) Can I eat and drink during labor? (2) Can I move around freely? (3) Can my partner/support person stay with me? (4) What natural pain relief options do you offer? (5) When do you recommend cesarean sections? (6) Will a midwife be involved in my care? Document your doctor’s answers and share them with your birth partner.
  • Throughout pregnancy, update your app with your doctor’s responses to birth preference questions. If you change doctors or hospitals, re-assess their approach. After birth, record which practices were actually supported and which weren’t, creating a personal record that helps you understand your care and inform future pregnancies or recommendations to other women.

This research describes what doctors in Brazil believe and practice regarding childbirth—it does not provide medical advice for your individual situation. Cesarean sections are sometimes medically necessary and life-saving. Always follow your doctor’s recommendations for your specific pregnancy, especially if you have health complications. If you’re pregnant, discuss birth preferences with your healthcare provider and ask about the evidence supporting different approaches. This study is informational and should not replace personalized medical guidance from your obstetrician or midwife.