A list of the top selling Brazilian women’s magazines for each of the years included in this review is available from the authors on request. The circulation of the eligible magazines ranged from 10
000 to 506
000 copies a month. During the 20 year period, we retrieved 13 different women’s magazines; as most of these magazines had monthly issues, we hand searched a total of 2868 different issues. Of these, 325 (11.3%) issues carried articles on pregnancy and childbirth that were considered potentially relevant and photocopied for analysis. After reading of the full text, 118 articles presented in separate issues fulfilled the selection criteria and were included in this study. The included articles, with specific information on caesarean section, represented 4.1% of all the issues published in Brazilian women’s magazines from 1988 to 2008 and 36% of all the articles on pregnancy and childbirth. All articles were written by Brazilian authors.
Table 1 shows the main characteristics of these articles. Most were more than one page in size and included several illustrations. Almost all (111/118) were written exclusively by journalists, three were written by health professionals alone, one was written by a reader, and three had no authorship. Health professionals were indicated as the main sources of information in almost 80% of the articles, medical journals were mentioned as sources in 10% of the articles, and 17% reported no specific source. We found 55 articles that presented the testimonials of women about their birthing experiences. These women reported 177 deliveries: 105 (59%) reported vaginal deliveries, and 72 (41%) reported caesarean sections. Most of these narratives had happy endings: 88% of deliveries by caesarean section and 98% of vaginal deliveries resulted in favourable maternal and perinatal outcomes (healthy mother and baby). More than half of the articles presented at least three medical facts on caesarean section, such as main maternal or fetal indications for caesarean section, details related to anaesthesia, and current rates of and statistics about caesarean section (table 2).
Table 1 Main characteristics and sources of information for articles on caesarean section published in Brazilian women’s magazines, 1988-2008. Values are numbers (percentages) unless stated otherwise
Table 2 Completeness of information on caesarean section transmitted in articles published in Brazilian women’s magazines 1988-2008. Values are numbers (percentages)
Figure 1 summarises the comprehensiveness of the information on potential benefits and risks of caesarean section provided in the articles. With regard to the benefits of caesarean section, although about 30% of the articles did not mention any benefit, more than 43% mentioned three or more benefits. Short term maternal risks were more frequently reported than were long term maternal risks and perinatal risks. Whereas only about 18% (n=21) of the articles did not mention any short term maternal risks related to caesarean section, 66% of the articles did not mention any long term maternal risks (n=78) or perinatal risks (n=77).
Fig 1Information on caesarean section presented by 118 articles published in Brazilian women’s magazines, 1988-2008
Figure 2 compiles the information provided by magazines on the benefits and risks of caesarean section (detailed information provided in the web appendix). The main reported benefits of caesarean section (top right quadrant) were reduction of pain during delivery (mentioned by almost half of the articles), convenience for health professionals and family, and the possibility of choosing when to deliver (both mentioned by about 40% (n=48) of the articles). Prevention of urinary incontinence was reported in 9% (n=11) of the articles and preservation of sexual function and satisfaction in 7% (n=8).
Fig 2Information on benefits and risks of caesarean section transmitted to women by magazines in Brazil
As figure 1 shows, more than 80% (n=97) of the articles mentioned at least one short term maternal risk or inconvenience related to caesarean section. Most focused mainly on the increased time needed for the mother to recover after a caesarean section (n=48) and the fact that it is a less natural way of giving birth (n=47), which were each mentioned by approximately 40% of the articles. About 34% (n=40) of the articles pointed out the passive role of women or less control of the birth process as a negative characteristic of caesarean section. Less than 20% (n=22) of the articles mentioned that delivery through caesarean section exposed the woman to increased risk of haemorrhage, hysterectomy, or blood transfusions, and only 14% (n=16) mentioned increased risk of death. Less than 10% (n=8) mentioned the possibility of lesions to the bladder, ureters, or intestines, and approximately 2% (n=2) informed women that thromboembolism could occur as a consequence of caesarean section.
Less than a third of the articles provided information on long term maternal risks of caesarean section (bottom left quadrant of fig 2). The most frequently mentioned risks were increased possibility of repeat caesarean section and uterine rupture in future deliveries (reported by about 19% (n=22) of articles). The possible occurrence of adhesions or chronic pains after repeated caesarean section was mentioned in 7% (n=8) of the articles, and increased risk of placenta praevia/accreta in 2.5% (n=3).
Approximately two thirds of the articles did not provide any information on increased perinatal risks associated with caesarean section (upper left quadrant of fig 2). The most frequently mentioned perinatal risk associated with caesarean section was increased incidence of respiratory discomfort and iatrogenic prematurity (mentioned by approximately 20% (n=25) of the articles).
Table 3 shows the reasons why women would request a caesarean section. According to the 55 articles that mentioned reasons for wanting an elective antepartum caesarean section, the most frequently cited reason was “to avoid labour pain” followed by “family convenience.” Eleven national celebrities described their experiences at giving birth to a total 13 infants (two women had two deliveries each): eight actresses, one singer, one basketball player, and the wife of an ex-president. Most (8/11) of these women had delivered vaginally and described the experience in positive terms. Three of the deliveries by caesarean section were considered positive by the celebrities and two were described in negative terms.
Table 3 Reasons why women would request elective (without medical indication) caesarean section according to Brazilian women’s magazines, 1988-2008. Values are numbers (percentages)