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Classification of cesarean sections among immigrants in Belgium
Anne-Frederique Minsart1, Myriam De Spiegelaere, Yvon Englert
1Perinatal Epidemiology Center (CEpiP) School of Public Health, University Hospital Erasme and Faculty of Medicine, Free University of Brussels, Brussels, Belgium. aminsart@ulb.ac.be
Objective:
To provide insight into the differential effect of immigration on cesarean section (CS) rates, using the Robson classification.
Design:
A population-based study using birth certificates from the birth registry of 2009.
Setting:
All births in two of the three Belgian regions excluding Flanders.
Population:
37 628 deliveries from Belgian and immigrant mothers from sub-Saharan Africa, Maghreb and Eastern Europe.
Methods:
Multivariate analyses using CS as the dependent variable and immigration status as the primary independent variable. Several multivariate logistic regression models were built including medical, anthropometric, socio-economic characteristics, and medical interventions. The impact of analyzing all delivery sites together was tested using mixed-effect analyses.
Main Outcome Measures:
CSs of immigrant subgroups compared with Belgian women.
Results:
CS rates varied according to immigrant subgroups. Mothers from sub-Saharan Africa had an adjusted odds ratio of 2.06 (1.62-2.63) for CS compared with Belgian natives. Increased risk for mothers from sub-Saharan Africa compared with Belgian natives was found among nulliparous and multiparous women without previous CS, and a term, singleton fetus in cephalic position. In comparison, nulliparous East European mothers with a term singleton fetus in cephalic position in spontaneous labor had an adjusted odds ratio of 0.29 (0.08-0.99) for CS.
Conclusions:
CS rates currently vary between Robson categories in immigrant subgroups. Immigrant mothers from sub-Saharan Africa with a term, singleton infant in cephalic position, without previous CS, appear to carry the highest burden.
