Public hospitals in ABC region lead with 53% natural births; private sector averages 90% cesareans

The public hospitals across the ABC region—São Bernardo, Diadema, Ribeirão Pires, and Santo André—delivered more than half their babies vaginally in 2025. Of 8,412 births that year, 4,489 came through natural labor, a rate of 53.36 percent. The cesarean section accounted for the remaining 46.64 percent. These numbers align with what medical organizations recommend as sound obstetric practice. But step into a private hospital in the same region, and the picture inverts almost entirely. At facilities like Santa Casa de Mauá, cesarean sections exceeded 90 percent of all deliveries. At Hospital NotreCare ABC, operated by Hapvida, three-quarters of the 4,025 births in 2025 were surgical.

The disparity is not accidental. It reflects fundamentally different approaches to pregnancy and birth—one rooted in physiology and patient autonomy, the other shaped by convenience, fear, and financial incentive. In the public system, women receive structured preparation for vaginal birth. They learn breathing techniques, use warm baths and therapeutic balls, move freely during labor, and have companions present. At NotreCare, the network has begun expanding these same practices, and the results show: their natural birth rate climbed to 32 percent, well above the national private sector average of 22 percent. Yet even this progress leaves them far behind the public hospitals.

Rebeca de Lira Nicolussi, twenty-three years old, arrived at NotreCare convinced she could not birth vaginally. People around her had told her cesarean was the only sensible choice. But during her pregnancy, she toured the hospital, received clear explanations from staff about how labor works, and felt genuinely heard. "I discovered I have a strength greater than I imagined," she said after delivering her daughter Liz naturally. The shift in her thinking came not from medical necessity but from information and reassurance—the very things that distinguish the two systems.

Penélope Lara, an obstetric nurse and coordinator of maternal services at NotreCare, explains that natural birth offers genuine physiological benefits for both mother and baby. Pain, however, remains the primary obstacle. The solution is not surgery but support: non-pharmaceutical methods first, then pharmacological pain relief if needed, always guided by clinical judgment. International health indicators recognize adequate natural birth rates as a marker of quality maternal care. Recovery after vaginal birth is faster and less complicated than after surgery. The bond between mother and infant forms more readily. Breastfeeding begins more smoothly.

Dr. Eduardo Fama, a gynecologist and professor at Centro Universitário FMABC, distinguishes between cesareans that save lives and those that do not. When a fetus shows signs of distress, when the baby's head is too large for the pelvis, when the placenta blocks the birth canal, or when labor fails to progress, surgery becomes necessary and can be lifesaving. But unnecessary cesareans carry real costs. Women face increased risk of infection, blood clots, hemorrhage, and in future pregnancies, dangerous placental abnormalities. Infants born by unnecessary cesarean are more likely to arrive prematurely and to suffer physical trauma. These risks accumulate across a woman's reproductive life.

The public hospitals in ABC have held cesarean rates steady around 46 percent over the past two years, even as births declined slightly from 9,328 in 2024 to 8,412 in 2025. Diadema, Ribeirão Pires, Santo André, and São Bernardo all maintained similar patterns: roughly half natural births, half surgical. São Bernardo, the largest of the four, performed 4,081 deliveries in 2025, with 2,155 vaginal and 1,926 cesarean. The consistency suggests a system operating within evidence-based norms.

Fama emphasizes that humanized birth—one that respects the body's natural rhythms, honors the pregnant woman's agency, and minimizes unnecessary intervention—produces better outcomes. Women feel safer, experience fewer traumatic memories, and recover more completely. The presence of a companion, a multidisciplinary team, and honest communication all reduce stress and lower cesarean rates. What the public hospitals have built, and what the better private facilities are beginning to adopt, is not a rejection of surgery but a commitment to using it only when it truly serves mother and baby. The gap between 53 percent and 90 percent is not a gap in safety. It is a gap in philosophy, in trust, and in whose interests the system serves.