Predictors of Emergency Caesarean Birth Among International Migrant Women

Background: Many migrant women in industrialized countries have harmful health outcomes during pregnancy and birth. Internationally, caesarean birth rates are over 25% and are known to sometimes be associated with harmful health outcomes for mothers or infants.

Research Objective and Design: To determine the predictors of emergency caesarean among international migrant women, we recruited 1025 migrants post-birth in 1 of 12 hospitals in the 3 largest migrant-receiving Canadian cities. Logistic regression was used to model social, migration, health service, and bio-medical factors predictive of emergency caesarean.   

Results: Fourteen percent of international migrant women gave birth by emergency caesarean. A woman was at greatest risk if:  this was her first birth [OR= 5.4 (95% CI = 3.0, 9.8)]; the newborn weighed  >4000 grams [4.0 (2.2, 7.1)]; she was not covered by government-sponsored health insurance [2.8 (1.3, 6.0)]; she gave birth on a Friday [2.0 (1.2, 3.4)]; her labour had been induced [1.7 (1.1, 2.6)]; or her family income was <$30,000 CDN/yr [1.6 (1.1, 2.6)]. Conversely, being an asylum-seeker was protective against emergency caesarean sections when compared to being in the immigrant class [0.3 (0.2, 0.6)] and those in the refugee class also tended toward a decreased risk [0.5 (0.2, 1.0). Those from countries classified by the UN as having low gender equality tended  towards higher risks [1.9 (1.0, 3.7)].

Impact and Conclusions: Migration status as well as bio-medical, social and health service factors are associated with emergency caesarean birth among international migrant women. Public health responses to address healthcare access and poverty among migrants may reduce risk of emergency caesarean among this group. The protective effect of being an asylum-seeker warrants further investigation.