Trends and consequences of the technocratic paradigm of childbirth in Portugal: A population-based analysis of birth conditions and social characteristics of parents.

OBJECTIVE: The aim of this paper is to analyse the evolution of birth conditions in Portugal and to establish a correspondence between maternity care and the socio-economic characteristics of new mothers.

METHODS: A multivariate quantitative analysis (Multiple Correspondence Analysis and Cluster Analysis) was used, based on official quantitative data from different surveys.

RESULTS: There is a consistent trend to a technocratic model of birth in the Portuguese context, where socio-economic characteristics appear to influence fertility rates and birth conditions. The evolution of birth conditions in Portugal reveal the institutionalisation of birth, with a strong presence of doctors, a higher frequency of births on certain weekdays, an increase in the proportion of births in private hospitals and an increase in the frequency of caesarean sections. There is an association between higher social status and more medicalised forms of assistance in childbirth. Women with higher levels of education, aged between 30 and 39years and who were married tended to be distinguished from the population of Portuguese women as a whole by three factors: birth in a hospital, the standardisation of pregnancy duration and the presence of a doctor at the birth. Women's educational and professional status also appears to influence their adoption of alternative models of birth, however, such as home birth.

DISCUSSION: Limiting the study of childbirth to its medical aspects leaves important dimensions out of the analysis: women's perception of birth-related risks associated with the medicalised offer of maternity care, and the implications of this childbirth paradigm for health outcomes and for future care.