# Impact of legal regulation on elective cesarean sections in a secondary complexity maternity hospital in São Paulo state

## TL;DR

A new law in São Paulo allowing elective cesareans without medical reasons led to a rise in cesarean rates at a public hospital, with no major differences in complications.

## Contribution

The study evaluates the real-world impact of a specific law on elective cesarean rates and associated outcomes in a public maternity hospital.

## Key findings

- Cesarean section rates increased from 23.6% to 27.7% after the law was implemented.
- 15.1% of cesareans during the law period were performed under maternal request.
- No significant differences in maternal or neonatal complications were found between elective and medically indicated cesareans.

## Abstract

To evaluate the impact of São Paulo State Law n° 17.137/2019 on the cesarean section rate at a public secondary-level maternity hospital and to analyze predictive factors and complications associated with cesarean under request. This law was enacted to allow pregnant women in São Paulo to request a cesarean section without medical indication.

This retrospective study analyzed medical records of pregnant women ≥ 39 weeks gestation attended at the Ribeirão Preto Women's Health Reference Center (CRSMRP-Mater). Two groups were evaluated: 1,999 patients before the law (July 2018–July 2019) and 3,207 after its implementation (August 2019–July 2021, excluding the suspension period). Descriptive and analytical statistical methods were applied.

The overall cesarean rates increased significantly from 23.6% to 27.7% (p < 0.01), with 15,1% of cesareans during the law period being under maternal request (134 patients). A previous cesarean was the only factor significantly associated with electing a new cesarean. Hospital length of stay was significantly longer in the law period (p < 0.01), possibly reflecting the increased cesarean rate. No significant differences were observed in maternal or neonatal complications between cesareans under request and those conducted for medical reasons.

São Paulo State Law n°. 17.137/2019 was associated with an increased cesarean rate in CRSMRP-Mater. The findings highlight the need for robust educational approaches and evidence-based obstetric practices to reduce unnecessary elective cesareans.