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,Jihong Liu,Sudha Xirasagar,Janice C Probst

doi:10.1186/1471-2458-10-548

Abstract

BackgroundCultural 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.MethodsWe 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.ResultsUnadjusted 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).ConclusionImmigrant 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).

Highlights

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
Taiwanese mothers had the highest prevalence of previous cesarean (14.9%), and Vietnamese the lowest (6.8%)
Taiwan’s Vietnamese immigrants show almost identical rates to immigrant Vietnamese in Norway [19] and to their home country [17]. Another validating finding in our study is that VBAC rates, which depend on maternal acceptability of a trial of labor follows the pattern observed with cesarean rates, the magnitude of VBAC rates itself is low

Summary

Introduction

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. 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. 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]. Changing marital and childbearing preferences of native-born Taiwanese women has resulted in many Taiwanese men, 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]

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Conclusion