Predictors of Unplanned Cesareans among Low-Risk Migrant Women from Low- and Middle-Income Countries Living in Montreal, Canada.
Research has yielded little understanding of factors associated with high cesarean rates among migrant women (i.e., women born abroad). The objective of this study was to identify medical, migration, social, and health service predictors of unplanned cesareans among low-risk migrant women from low- and middle-income countries (LMICs).



We used a case-control research design. The sampling frame included migrant women from LMICs living in Canada less than 8 years, who gave birth at one of three Montreal hospitals between March 2014 and January 2015. Data were collected from medical records and by interview-administration of the Migrant-Friendly Maternity Care Questionnaire. We performed multi-variable logistic regression for low-risk women (i.e., vertex, singleton, term pregnancies) who delivered vaginally (1,615 controls) and by unplanned cesarean indicated by failure to progress, fetal distress, or cephalopelvic disproportion (233 cases).



Predictors of unplanned cesarean included being from sub-Saharan Africa/Caribbean (OR 2.37 [95% CI 1.02-5.51]) and admission for delivery during early labor (OR 5.43 [95% CI 3.17-9.29]). Among women living in Canada less than 2 years predictors were having a humanitarian migration classification (OR 4.24 [95% CI 1.16-15.46]) and admission for delivery during early labor (OR 7.68 [95% CI 3.12-18.88]).



Migrant women from sub-Saharan Africa/Caribbean and recently arrived migrant women with a humanitarian classification are at greater risk for unplanned cesareans compared with other low-risk migrant women from LMICs after controlling for medical factors. Strategies to prevent cesareans should consider the circumstances of migrant women that may be contributing to the use of unplanned cesareans in this population.
School of Nursing, University of Ottawa, Ottawa, Canada.
Lisa
L
Merry
Ingram School of Nursing, McGill University, Montreal, QC, Canada.|Women's Health Mission, McGill University Health Centre (MUHC), Montreal, QC, Canada.
Sonia
S
Semenic
Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, QC, Canada.|Division of Clinical Epidemiology, McGill University Health Centre (MUHC), Montreal, QC, Canada.
Theresa W
TW
Gyorkos
Centre hospitalier universitaire de Sherbrooke (CHUS) Research Centre, Sherbrooke, QC, Canada.|Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke, QC, Canada.
William
W
Fraser
Ingram School of Nursing, Montreal, QC, Canada.|The Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, QC, Canada.
Anita J
AJ
Gagnon
D000328:Adult; D002170:Canada; D016022:Case-Control Studies; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003906:Developing Countries; D005260:Female; D006801:Humans; D016015:Logistic Models; D011247:Pregnancy; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D014171:Transients and Migrants / Q000706:statistics & numerical data*
humanitarian migrants; migration; predictors; unplanned cesarean