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

BMC Public Health, Sep 2010

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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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). - 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)


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Jung-Chung Fu, Sudha Xirasagar, Jihong Liu, Janice C Probst. 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, BMC Public Health, 2010, pp. 548, 10, DOI: 10.1186/1471-2458-10-548