Predictors of Emergency Caesarean Births to Low-Risk Migrant Women
Merry, L.; Semenic, S.; Gyorkos, T.; Fraser, W.; Gagnon, AJ. (2015)
European Journal of Public Health
25(suppl_3) | On line
Background
The high number of caesareans performed in High Income Countries (HICs) is of concern due to associated risks. Recommendations to reduce caesarean rates include preventing emergency caesareans among low-risk women (i.e., vertex, singleton, term pregnancies). Pregnant migrant women from low or middle income countries (LMICs) may face conditions that exacerbate childbearing and delivery health risks. The objective of this study was to identify medical, migration, social and health service predictors associated with emergency caesareans in low-risk migrant women from LMICs.
Methods
Using a case-control research design, migrant women from LMICs, and living in Canada ≤ 8 years were recruited from the postpartum units of three hospitals in a major urban Canadian city between March 2014 and January 2015. Data were collected from medical records and by administration of the Migrant-Friendly Maternity Care questionnaire (available in 8 languages). Low risk women who delivered by emergency caesarean for discretionary indications (cases) or vaginally (controls) were included in analyses. Multi-variable logistic regression was performed to identify predictors of emergency caesarean.
Results
233 cases and 1615 controls were analyzed. Predictors of emergency caesarean were: pre-pregnancy BMI ≥ 25 and/or excessive pregnancy weight gain (OR = 1.49, 95% CI 1.02-2.13), poor maternal health (OR = 1.38, 95% CI 0.95-1.98), admission to birthing centre < 4 cm dilated (OR = 6.48, 95% CI 3.50-12.01), maternal region of birth Sub-Saharan African/Caribbean (OR = 2.39, 95% CI 0.95-5.99), and length of time in Canada < 2 years (OR = 2.04, 95% CI 1.04-4.03). Among women < 2 years in Canada, gestational diabetes and/or hypertension (OR = 2.07, 95% CI 0.98-4.35), having a humanitarian migration classification (OR = 4.48, 95%CI 1.21-16.49), and admission to the birthing centre < 4 cm dilated (OR = 7.43, 95% CI 3.04-18.18) were important predictors.
Conclusion
There are important migration, medical, and health service predictors of emergency caesareans to migrant women from LMICs.