Caesarean delivery in a migration context: the role of prior delivery in the host country

Abstract

Migrant women in industrialised countries experience high caesarean section (CS) rates but little is known about the effect of a previous delivery in the host country. This study set out to investigate this effect among migrant women in France, using data from the DSAFHIR study on healthcare access of migrant women living in emergency housing hotels, collected in the Paris Metropolitan area in 2017. Respondents reported life-long history of deliveries. We focused on deliveries occurring in France in 2000–2017: 370 deliveries reported by 242 respondents. We conducted chi-square tests and multivariate logistic regressions, adjusting for the clustering of deliveries among respondents by computing standard errors allowing for intragroup correlation. Mode of delivery was associated with duration of residence among multiparous women with no prior CS, with a higher CS rate with shorter duration of residence (16% vs. 7%, p = 0.04). In this group, a previous delivery in France was associated with a lower CS rate (5% vs. 16%, p = 0.008). In multivariate analysis, compared with women with previous birth in France, women giving birth in France for the first time had a higher risk of CS, regardless of duration of residence (aOR = 4.0, 95% CI = 1.3–12.1 for respondents with short duration of residence, aOR = 4.7, 95% CI = 1.2–18.0 for respondents with longer duration of residence). Efforts directed at decreasing the CS rate among migrant women should target women giving birth in the host country for the first time.

Association between Maternal Origin, Pre-Pregnancy Body Mass Index and Caesarean Section: A Nation-Wide Registry Study

“…Adjusting for pre-pregnancy BMI did not change the estimates substantially. Other studies support this finding [ 8 , 38 , 39 ]. Only women with a long length of residence from Europe & Central Asia had elevated risk of elective CS.…”

“…The CS rate varies between countries but also within countries between migrant and non-migrant women [ 6 ]. Non-medical factors, such as fear of birth, maternal age, network support, lack of health insurance, communication barriers, education, literacy, and lifestyle behavior, may partly explain differences in CS rates [ 7 , 8 , 9 ]. Some studies have reported higher rates of CS among migrant women compared to women born in the host country [ 8 ], but studies are inconclusive as both a higher and a lower rate of CS has been observed [ 10 ].…”

Cesarean birth rates among migrants in Europe: A systematic review

“…One additional paper was identified for full‐text assessment through searching reference lists of included studies, resulting in full‐text assessment being carried out on 54 papers in total. Twenty‐one papers were included in the final review and analysis 28–48 . Figure 1 illustrates the selection process, the number of studies identified and excluded at each stage, and the reasons for exclusion, in line with the PRISMA 2020 statement 49 .…”

Immigration and C-sections incidence: Maternal care and perinatal outcomes in the context of the pandemic in Chile

“…In 20 years, it went from being 0.8% in 1992, to 7.5% in 2021 (1), however, due to their demographic characteristics, immigrants' mothers account for the 16.4% of live births, with the top five maternal nationalities being Haiti (21.6%), Venezuela (17.1%), Peru (12.5%), Bolivia (7.9%), and Colombia (6.8%) (2). Some international studies have reported higher C-section rates among the immigrant population compared to the local population (3,4). While the causes for these higher rates remain unknown, certain risk factors have been identified, such as language or communication barriers, inadequate prenatal care even after a shorter stay in the host country, socioeconomic status, and lack of health insurance (5,6).…”