Socioeconomic and migration status as predictors of emergency caesarean section: a birth cohort study

Abstract

Background: Women with a migration background are reportedly at a higher risk of emergency caesarean section. There is evidence that this is due in part to suboptimal antenatal care use and quality of care. Despite the fact that migrant women and descendants of migrants are often at risk of socioeconomic disadvantage, there is, in comparison, scarce and incomplete evidence on the role of socioeconomic position as an independent risk factor for emergency caesarean delivery. We therefore investigate whether and how migration background and two markers of socioeconomic position affect the risk of an emergency caesarean section and whether they interact with each other. Methods: In 2013-2016, we recruited women during the perinatal period in Bielefeld, Germany, collecting data on health and socioeconomic and migration background, as well as routine perinatal data. We studied associations between migration background (1st generation migrant, 2nd/3rd generation woman, no migration background), socioeconomic status (educational attainment and net monthly household income), and the outcome emergency caesarean section. Results: Of the 881 participants, 21% (n = 185) had an emergency caesarean section. Analyses showed no association between having an emergency caesarean section and migration status or education. Women in the lowest (< 800€/month) and second lowest (between 800 and 1750€/month) income categories were more likely (aOR: 1.96, CI: 1. and aOR: 2.36, respectively) to undergo an emergency caesarean section than women in the higher income groups. Conclusions: Migration status and education did not explain heterogeneity in mode of birth. Having a low household income, however, increased the chances of emergency caesarean section and thereby contributed towards producing health disadvantages. Awareness of these findings and measures to correct these inequalities could help to improve the quality of obstetric care.

Prevalence and Factors Associated With Caesarean Delivery in Nepal: Evidence From a Nationally Representative Sample

“…However, this study did identify nine factors associated with CS delivery in Nepal, which is essential given rising rates [ 30 ]. These included older age-group of 30 years old or more, being rich, overweight, and obese, using the internet, ANC visits of more than four times, ANC by doctors, twin delivery, big babies of 4 kg or more, and having more than two or more children.…”

“…These include maternal socio-economical determinants incorporating maternal age, residence, education, income, and the number of antenatal care (ANC) during pregnancy and other factors, including body mass index, number of children, the preceding birth interval, and media exposure [28][29][30]. Maternal age of fewer than 30 years [19][20][31][32][33] is considered to lower the risk of comorbidities associated with CS [34][35], with advanced maternal age, i.e., 35 years or more, found to significantly increase the rate of CS and adverse outcomes [1,13,30,34,[36][37]. With advancing age, the overall rate of CS doubles from 21% (<20 years) to 42% (≥35 years), enhanced by repeated pre-labour CS [28].…”

Potential of Standard Perinatal Data for Measuring Violation of Birth Integrity

“…By nature, the perinatal data comprise, for the majority, medical variables, measures, and indicators that have the advantage of being standardized internationally (e.g., Apgar score). The data collected in hospitals has some medical relevance for the individual patient and respond to needs for organizational monitoring, and beyond, population health assessment and epidemiological endeavors [e.g., (34,35)]. One could envisage another dimension, theoretically and ethically grounded, which TABLE 1 | Dimensions of vBI and corresponding vBI-related variables of interest that are included in, or missing from, the perinatal data.…”

Immigration and Adverse Pregnancy Outcomes in an Italian Free Care Hospital

“…The prevalence was in line with that seen in other European countries, such as Turkish (32%) 22 and Germany (32.9%). 23 We analyzed the obstetric outcomes of 1092 immigrants compared to 2464 native patients, with a glimpse into potential differences in pregnancy complications. In Italy, hospitalization, surgical procedures, and necessary medications are provided free of charge for the immigrant population as established by the health system.…”

“…Recently, several Italian hospitals have focused their research on the obstetric outcomes of immigrated women compared to the native population; however, results were quite heterogeneous. [22][23][24][25] The aim of the study was to compare pregnancy and perinatal outcomes between long-term (≥ 2 years of residence) immigrant women and the native population in an Italian free care hospital.…”