title: Rates of obstetric intervention during birth and selected maternal and perinatal outcomes for low risk women born in Australia compared to those born overseas.
abstract: BACKGROUND
  There are mixed reports in the literature about obstetric intervention and maternal and neonatal outcomes for migrant women born in resource rich countries. The aim of this study was to compare the risk profile, rates of obstetric intervention and selected maternal and perinatal outcomes for low risk women born in Australia compared to those born overseas.
  
  
  METHODS
  A population-based descriptive study was undertaken in NSW of all singleton births recorded in the NSW Midwives Data Collection between 2000-2008 (n=691,738). Risk profile, obstetric intervention rates and selected maternal and perinatal outcomes were examined.
  
  
  RESULTS
  Women born in Australia were slightly younger (30 vs 31 years), less likely to be primiparous (41% vs 43%), three times more likely to smoke (18% vs 6%) and more likely to give birth in a private hospital (26% vs 18%) compared to women not born in Australia. Among the seven most common migrant groups to Australia, women born in Lebanon were the youngest, least likely to be primiparous and least likely to give birth in a private hospital. Hypertension was lowest amongst Vietnamese women (3%) and gestational diabetes highest amongst women born in China (14%). The highest caesarean section (31%), instrumental birth rates (16%) and episiotomy rates (32%) were seen in Indian women, along with the highest rates of babies <10th centile (22%) and <3rd centile (8%). Lebanese women had the highest rates of stillbirth (7.2/1000). Similar trends were found in the different migrant groups when only low risk women were included.
  
  
  CONCLUSIONS
  The results suggest there are significant differences in risk profiles, obstetric intervention rates and maternal and neonatal outcomes between Australian-born and women born overseas and these differences are seen overall and in low risk populations. The finding that Indian women (the leading migrant group to Australia) have the lowest normal birth rate and high rates of low birth weight babies is concerning, and attention needs to be focused on why there are disparities in outcomes and on effective models of care that might improve outcomes for this population.
authors: Hannah G
authors: HG
authors: Dahlen
authors: Virginia
authors: V
authors: Schmied
authors: Cindy-Lee
authors: CL
authors: Dennis
authors: Charlene
authors: C
authors: Thornton
mesh_terms: D000328:Adult; D017677:Age Distribution; D001315:Australia; D001724:Birth Weight; D002585:Cesarean Section / Q000706:statistics & numerical data; D002681:China / Q000208:ethnology; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D016640:Diabetes, Gestational / Q000453:epidemiology*; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D004739:England / Q000208:ethnology; D004841:Episiotomy / Q000706:statistics & numerical data*; D005113:Extraction, Obstetrical / Q000706:statistics & numerical data; D005260:Female; D016304:Hospitals, Private; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology*; D007194:India / Q000208:ethnology; D007231:Infant, Newborn; D007751:Labor, Induced / Q000706:statistics & numerical data; D007861:Lebanon / Q000208:ethnology; D009520:New Zealand / Q000208:ethnology; D010298:Parity; D010679:Philippines / Q000208:ethnology; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology*; D012907:Smoking / Q000453:epidemiology*; D050497:Stillbirth / Q000453:epidemiology; D014744:Vietnam / Q000208:ethnology; D055815:Young Adult
references: Am J Prev Med. 2001 Jul;21(1):52-9
references: 11418258
references: Acta Obstet Gynecol Scand. 2000 Jul;79(7):553-8
references: 10929954
references: BMC Pregnancy Childbirth. 2012 Dec 27;12:163
references: 23270315
references: Med J Aust. 1988 Nov 7;149(9):457-60
references: 3185340
references: Soc Sci Med. 2009 Sep;69(6):934-46
references: 19664869
references: BJOG. 2007 Oct;114(10):1232-9
references: 17655734
references: Am J Public Health. 2003 Feb;93(2):248-55
references: 12554578
references: BMC Public Health. 2012 Jun 13;12:333
references: 22569183
references: BMJ Open. 2012 Sep 10;2(5):
references: 22964120
references: BJOG. 2003 Feb;110(2):97-105
references: 12618151
references: BJOG. 2000 Dec;107(12):1507-12
references: 11192108
references: N Engl J Med. 2005 Jun 16;352(24):2477-86
references: 15951574
references: Int J Public Health. 2007;52(4):210-22
references: 18030953
references: Women Health. 1999;28(3):77-101
references: 10374809
references: Midwifery. 2013 Sep;29(9):1019-26
references: 23415355
references: Birth. 2002 Dec;29(4):266-77
references: 12431266
references: Med J Aust. 2009 May 4;190(9):474-7
references: 19413516
references: Med J Aust. 1986 Jun 23;144(13):721-2
references: 3724606
references: J Inherit Metab Dis. 2007 Aug;30(4):482-9
references: 17701444
references: BMJ. 2000 Jul 15;321(7254):137-41
references: 10894690
references: BMC Pregnancy Childbirth. 2013 Jan 30;13:27
references: 23360183
references: Epidemiology. 2004 Nov;15(6):679-86
references: 15475716
references: Paediatr Perinat Epidemiol. 2006 Mar;20(2):140-7
references: 16466432
references: Aust N Z J Obstet Gynaecol. 2004 Dec;44(6):541-4
references: 15598293
references: BMC Public Health. 2009 Mar 20;9:84
references: 19298682
references: Paediatr Perinat Epidemiol. 2009 Mar;23(2):144-52
references: 19159400
references: J Epidemiol Community Health. 2009 Sep;63(9):755-60
references: 19679715
references: Acta Obstet Gynecol Scand. 2009;88(2):134-48
references: 19096947
references: BMJ. 2001 May 5;322(7294):1089-93; discussion 1093-4
references: 11337436
references: Diabetes Care. 2007 Apr;30(4):878-83
references: 17392549
references: Aust N Z J Obstet Gynaecol. 2005 Feb;45(1):36-41
references: 15730363
references: Paediatr Perinat Epidemiol. 2000 Jul;14(3):192-3
references: 10949210
references: Soc Sci Med. 2005 Mar;60(6):1251-66
references: 15626522
references: BMC Public Health. 2006 Mar 27;6:78
references: 16566833
references: J Biosoc Sci. 2009 Jul;41(4):505-17
references: 19175949
references: Soc Sci Med. 2003 Sep;57(5):895-904
references: 12850114
references: Ir Med J. 2001 Mar;94(3):79-80
references: 11354688
references: CMAJ. 2007 May 8;176(10):1439-40
references: 17485696
references: Soc Sci Med. 1999 May;48(9):1237-45
references: 10220022
references: Open Med. 2007 Jul 10;1(2):e74-88
references: 20101298
references: J Epidemiol Community Health. 2008 May;62(5):402-9
references: 18413452
references: BJOG. 2012 Nov;119(12):1483-92
references: 22830446
references: Clin Genet. 1997 Sep;52(3):142-6
references: 9377802
references: Am J Epidemiol. 1995 Jun 15;141(12):1177-87
references: 7771456
references: Am J Hum Biol. 2010 Jan-Feb;22(1):1-17
references: 19844897