The Brazilian preference: cesarean delivery among immigrants in Portugal

To evaluate how the country of origin affects the probability of being delivered by cesarean section when giving birth at public Portuguese hospitals. Women delivered of a singleton birth (n = 8228), recruited from five public level III maternities (April 2005-August 2006) during the procedure of as...

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Bibliographic Details
Published in:PloS one 2013-03, Vol.8 (3), p.e60168-e60168
Main Authors: Teixeira, Cristina, Correia, Sofia, Victora, César G, Barros, Henrique
Format: Article
Language:English
Subjects:
Adult
Brazil
Cesarean section
Cesarean Section - statistics & numerical data
Confidence intervals
Cultural differences
Emigrants and Immigrants - statistics & numerical data
Epidemiology
Female
Health risk assessment
Humans
Immigrants
Labor
Medicine
Migration
Noncitizens
Portugal
Pregnancy
Public health
Risk analysis
Risk factors
Socioeconomic factors
Statistical analysis
Womens health
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Summary:To evaluate how the country of origin affects the probability of being delivered by cesarean section when giving birth at public Portuguese hospitals. Women delivered of a singleton birth (n = 8228), recruited from five public level III maternities (April 2005-August 2006) during the procedure of assembling a birth cohort, were classified according to the country of origin and her migration status as Portuguese (n = 7908), non-Portuguese European (n = 84), African (n = 77) and Brazilian (n = 159). A Poisson model was used to evaluate the association between country of birth and cesarean section that was measured by adjusted prevalence ratio (PR) and respective 95% confidence intervals (95%CI). The cesarean section rate varied from 32.1% in non-Portuguese European to 48.4% in Brazilian women (p = 0.008). After adjustment for potential confounders and compared to Portuguese women as a reference, Brazilian women presented significantly higher prevalence of cesarean section (PR = 1.26; 95%CI: 1.08-1.47). The effect was more evident among multiparous women (PR = 1.39; 95%CI: 1.12-1.73) and it was observed when cesarean section was performed either before labor (PR = 1.43; 95%CI: 0.99-2.06) or during labor (PR = 1.30; 95%CI: 1.07-1.58). The rate of cesarean section was significantly higher among Brazilian women and it was independent of the presence of any known risk factors or usual clinical indications, suggesting that cultural background influences the mode of delivery overcoming the expected standard of care and outcomes in public health services.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0060168