title: Caesarean Section Frequency among Immigrants, Second- and Third-Generation Women, and Non-Immigrants: Prospective Study in Berlin/Germany.
abstract: OBJECTIVE
  The frequency of caesarean section delivery varies between countries and social groups. Among other factors, it is determined by the quality of obstetrics care. Rates of elective (planned) and emergency (in-labor) caesareans may also vary between immigrants (first generation), their offspring (second- and third-generation women), and non-immigrants because of access and language barriers. Other important points to be considered are whether caesarean section indications and the neonatal outcomes differ in babies delivered by caesarean between immigrants, their offspring, and non-immigrants.
  
  
  METHODS
  A standardized interview on admission to delivery wards at three Berlin obstetric hospitals was performed in a 12-month period in 2011/2012. Questions on socio-demographic and care aspects and on migration (immigrated herself vs. second- and third-generation women vs. non-immigrant) and acculturation status were included. Data was linked with information from the expectant mothers' antenatal records and with perinatal data routinely documented in the hospital. Regression modeling was used to adjust for age, parity and socio-economic status.
  
  
  RESULTS
  The caesarean section rates for immigrants, second- and third-generation women, and non-immigrant women were similar. Neither indications for caesarean section delivery nor neonatal outcomes showed statistically significant differences. The only difference found was a somewhat higher rate of crash caesarean sections per 100 births among first generation immigrants compared to non-immigrants.
  
  
  CONCLUSIONS
  Unlike earlier German studies and current studies from other European countries, this study did not find an increased rate of caesarean sections among immigrants, as well as second- and third-generation women, with the possible exception of a small high-risk group. This indicates an equally high quality of perinatal care for women with and without a migration history.
authors.affiliation: Charité University Medicine Berlin, Clinic for Gynaecology, Campus Virchow-Klinikum, Berlin, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: David
authors.affiliation: Alice Salomon Hochschule Berlin-University of Applied Sciences, Berlin, Germany.
authors.forename: Theda
authors.initials: T
authors.lastname: Borde
authors.affiliation: Charité University Medicine Berlin, Clinic for Gynaecology, Campus Virchow-Klinikum, Berlin, Germany.
authors.forename: Silke
authors.initials: S
authors.lastname: Brenne
authors.affiliation: Charité University Medicine Berlin, Obstetrics Clinics, Campus Virchow-Klinikum and Mitte, Berlin, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Henrich
authors.affiliation: Bielefeld University, School of Public Health, Department of Epidemiology & International Public Health, Bielefeld, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Breckenkamp
authors.affiliation: Bielefeld University, School of Public Health, Department of Epidemiology & International Public Health, Bielefeld, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Razum
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D003710:Demography; D004638:Emergency Treatment; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D011446:Prospective Studies; D055815:Young Adult