title: Classification of cesarean sections among immigrants in Belgium.
abstract: OBJECTIVE
  To provide insight into the differential effect of immigration on cesarean section (CS) rates, using the Robson classification.
  
  
  METHODS
  A population-based study using birth certificates from the birth registry of 2009.
  
  
  METHODS
  All births in two of the three Belgian regions excluding Flanders.
  
  
  METHODS
  37 628 deliveries from Belgian and immigrant mothers from sub-Saharan Africa, Maghreb and Eastern Europe.
  
  
  METHODS
  Multivariate analyses using CS as the dependent variable and immigration status as the primary independent variable. Several multivariate logistic regression models were built including medical, anthropometric, socio-economic characteristics, and medical interventions. The impact of analyzing all delivery sites together was tested using mixed-effect analyses.
  
  
  METHODS
  CSs of immigrant subgroups compared with Belgian women.
  
  
  RESULTS
  CS rates varied according to immigrant subgroups. Mothers from sub-Saharan Africa had an adjusted odds ratio of 2.06 (1.62-2.63) for CS compared with Belgian natives. Increased risk for mothers from sub-Saharan Africa compared with Belgian natives was found among nulliparous and multiparous women without previous CS, and a term, singleton fetus in cephalic position. In comparison, nulliparous East European mothers with a term singleton fetus in cephalic position in spontaneous labor had an adjusted odds ratio of 0.29 (0.08-0.99) for CS.
  
  
  CONCLUSIONS
  CS rates currently vary between Robson categories in immigrant subgroups. Immigrant mothers from sub-Saharan Africa with a term, singleton infant in cephalic position, without previous CS, appear to carry the highest burden.
authors.affiliation: Perinatal Epidemiology Center (CEpiP) School of Public Health, University Hospital Erasme and Faculty of Medicine, Free University of Brussels, Brussels, Belgium. aminsart@ulb.ac.be
authors.forename: Anne-Frederique
authors.initials: AF
authors.lastname: Minsart
authors.forename: Myriam
authors.initials: M
authors.lastname: De Spiegelaere
authors.forename: Yvon
authors.initials: Y
authors.lastname: Englert
authors.forename: Pierre
authors.initials: P
authors.lastname: Buekens
mesh_terms: D017954:Africa South of the Sahara / Q000208:ethnology; D001530:Belgium / Q000453:epidemiology; D015992:Body Mass Index; D002585:Cesarean Section / Q000145:classification* / Q000706:statistics & numerical data*; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015999:Multivariate Analysis; D054238:Perinatal Mortality; D011247:Pregnancy