Predictors of emergency cesarean delivery among international migrant women in Canada

ObjectiveTo determine the predictors of emergency cesarean delivery among international migrant women.MethodsBetween February 2006 and May 2009, 1025 postpartum migrant women were recruited from 12 hospitals in Toronto, Montreal, and Vancouver. Logistic regression was used to model migration, social, health service, and biomedical factors predictive of emergency cesarean.ResultsOverall, 14% percent of participants underwent emergency cesarean. The greatest risk was for women having their first delivery (odds ratio [OR], 5.9; 95% confidence interval [CI], 3.1–11.3); newborns weighing 4000 g or more (OR, 3.5; 95% CI, 1.9–6.5); no health insurance (OR, 2.8; 95% CI, 1.2–6.4); delivery on a Friday (OR, 2.2; 95% CI, 1.2–3.9); incomes of less than 30 000 Canadian dollars (OR, 1.9; 1.2–3.0); and induced labor (OR, 1.8; 95% CI, 1.1–3.0). Compared with immigrants, asylum seekers (OR, 0.3; 95% CI, 0.2–0.6) and refugees (OR, 0.5; 95% CI, 0.2–1.0) were protected against emergency cesarean.ConclusionIndicators specific to, or more common among, migrants were informative in assessing the likelihood of emergency cesarean. The risk associated with being uninsured, day of delivery, income, and immigration class suggests the importance of considering non-biomedical factors in reducing the need for emergency cesarean among migrants.