Cesarean and VBAC rates among immigrant vs. native-born women: a retrospective observational study from Taiwan Cesarean delivery and VBAC among immigrant women in Taiwan
Jung-Chung Fu
0
Sudha Xirasagar
2
Jihong Liu
1
Janice C Probst
2
0
Kaohsiung Municipal United Hospital, Department of Obstetrics & Gynecology.
Kaohsiung, ROC
,
Taiwan
1
University of South Carolina, Arnold School of Public Health, Department of Epidemiology and Biostatistics
,
Columbia, SC
,
USA
2
University of South Carolina, Arnold School of Public Health, Department of Health Services Policy and Management
,
Columbia, SC
,
USA
Background: Cultural and ethnic roots impact women's fertility and delivery preferences This study investigated whether the likelihood of cesarean delivery, primary cesarean, and vaginal delivery after cesarean (VBAC) varies by maternal national origin. Methods: We conducted a nation-wide, population-based, observational study using secondary data from Taiwan. De-identified data were obtained on all 392,246 singleton live births (500 g; 20 weeks) born to native-born Taiwanese, Vietnamese and mainland Chinese-born mothers between January 1 2006 and December 31 2007 from Taiwan's nation-wide birth certificate data. Our analytic samples consisted of the following: for overall cesarean likelihood 392,246 births, primary cesarean 336,766 (excluding repeat cesarean and VBAC), and VBAC 55,480 births (excluding primary cesarean and vaginal births without previous cesarean). Our main outcome measures were the odds of cesarean delivery, primary cesarean delivery and VBAC for Vietnamese and Chinese immigrant mothers relative to Taiwanese mothers, using multiple regression analyses to adjust for maternal and neonatal characteristics, paternal age, institutional setting, and major obstetric complications. Results: Unadjusted overall cesarean, primary cesarean, and VBAC rates were 33.9%, 23.0% and 4.0% for Taiwanese, 27.6%, 20.1% and 5.0% for mainland Chinese, and 19.3%, 13.9 and 6.1% for Vietnamese respectively. Adjusted for confounders, Vietnamese mothers were less likely than native-born Taiwanese to have overall and primary cesarean delivery (OR = 0.59 and 0.58 respectively), followed by Chinese mothers (both ORs = 0.90 relative to native-born Taiwanese). Vietnamese mothers were most likely to have successful VBAC (OR = 1.58), followed by Chinese mothers (OR = 1.25). Conclusion: Immigrant Vietnamese and Chinese mothers have lower odds of cesarean and higher VBAC odds than native-born Taiwanese, consistent with lower cesarean rates prevailing in their home countries (Vietnam 10.1%; mainland China 20% - 50% rural and urban respectively).
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Background
With increasing prosperity and higher educational
attainment of women, Taiwan is experiencing major social
changes in attitudes to marriage and child bearing. Many
Taiwanese women decline or delay marriage and
childbearing, which is reflected in a rapid fertility decline.
Taiwans current total fertility rate is 1.07, among the
lowest in the world [1,2]. Age at first marriage increased
from 30.7 to 31.1 years for men and from 26.9 to 28.4 for
women during 2004 to 2008 [3,4]. Maternal age at first
delivery increased from 26.4 years in 1998 to 28.9 years
in 2008[5]. Changing marital and childbearing
preferences of native-born Taiwanese women has resulted in
many Taiwanese men, particularly of lower
socioeconomic status (SES), education, income and rural
residence seeking brides from neighboring Asian countries
[6,7], the vast majority being mainland Chinese and
Vietnamese (12.5% of all marriages and 9.5% of births in
2008) [5,8].
Concurrent with the fertility decline among
nativeborn Taiwanese, cesarean rates have escalated to about
a third of all births, one of the highest in the world
[9,10]. Cesarean delivery is associated with higher
maternal and fetal risks, such as maternal mortality,
rehospitalization for wound complications and infection,
placental abnormalities in subsequent births (placenta
accrete, percreta and previa), uterine rupture, preterm
births, neonatal complications and higher costs [11-15].
Cesarean rates by maternal ethnicity of origin have not
been systematically studied.
Cultural-ethnic-national origin of women plausibly
impacts fertility and birthing preferences. High cesarean
rates in Latin America [16], and a low rate of 10.1% in
Vietnam [17] are documented. Literature suggests that
cesarean rates among immigrant women mirror the
rates prevailing in their home countries. Vietnamese
immigrant mothers have lower cesarean rates than the
host country rate in many countries. In Switzerland,
Vietnamese-immigrant mothers lower have cesarean
rates than Latin American immigrants [18], and lower
than the nation-wide CS rate. In Norway, Vietnamese
immigrants had a 10.1% cesarean rate compared to
24.3% for Latin American immigrants from Chile and
Brazil [19]. The latter rate is closer to the domestic
cesarean rates in Brazil 36% (16), and Chile 40% in 1997
[20], and to the overall South American regions rate of
33% reported by the World Health Organization [21].
Apart from the cesarean rates in Vietnam, the rates in
mainland Chi (...truncated)