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Predictors of Unplanned Cesareans among Low‐Risk Migrant Women from Low‐ and Middle‐Income Countries Living in Montreal, Canada
Author(s) -
Merry Lisa,
Semenic Sonia,
Gyorkos Theresa W.,
Fraser William,
Gag Anita J.
Publication year - 2016
Publication title -
birth
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.233
H-Index - 83
eISSN - 1523-536X
pISSN - 0730-7659
DOI - 10.1111/birt.12234
Subject(s) - demographic economics , low income , immigration , demography , medicine , gerontology , geography , sociology , economics , archaeology
Background Research has yielded little understanding of factors associated with high cesarean rates among migrant women (i.e., women born abroad). The objective of this study was to identify medical, migration, social, and health service predictors of unplanned cesareans among low‐risk migrant women from low‐ and middle‐income countries ( LMIC s). Methods We used a case–control research design. The sampling frame included migrant women from LMIC s living in Canada less than 8 years, who gave birth at one of three Montreal hospitals between March 2014 and January 2015. Data were collected from medical records and by interview‐administration of the Migrant‐Friendly Maternity Care Questionnaire. We performed multi‐variable logistic regression for low‐risk women (i.e., vertex, singleton, term pregnancies) who delivered vaginally (1,615 controls) and by unplanned cesarean indicated by failure to progress, fetal distress, or cephalopelvic disproportion (233 cases). Results Predictors of unplanned cesarean included being from sub‐Saharan Africa/Caribbean ( OR 2.37 [95% CI 1.02–5.51]) and admission for delivery during early labor ( OR 5.43 [95% CI 3.17–9.29]). Among women living in Canada less than 2 years predictors were having a humanitarian migration classification ( OR 4.24 [95% CI 1.16–15.46]) and admission for delivery during early labor ( OR 7.68 [95% CI 3.12–18.88]). Conclusion Migrant women from sub‐Saharan Africa/Caribbean and recently arrived migrant women with a humanitarian classification are at greater risk for unplanned cesareans compared with other low‐risk migrant women from LMIC s after controlling for medical factors. Strategies to prevent cesareans should consider the circumstances of migrant women that may be contributing to the use of unplanned cesareans in this population.