title: International migration as a determinant of emergency caesarean.
abstract: BACKGROUND
  High caesarean rates are of concern given associated risks. International migrant women (women born abroad) represent a substantial proportion of women giving birth in high-income countries (HICs) and face social conditions that may exacerbate childbearing health risks. Among migrant women, emergency rather than planned caesareans, tend to be more prevalent. This method of delivery can be stressful, physically harmful and result in an overall negative birth experience. Research establishing evidence of risk factors for emergency caesareans in migrants is insufficient.
  
  
  OBJECTIVE
  (1) Describe potential pathways (with a focus on modifiable factors) by which migration, using internationally recommended migration indicators: country of birth, length of time in country, fluency in receiving-country language, migration classification and ethnicity, may lead to emergency caesarean; and (2) propose a framework to guide future research for understanding "potentially preventable" emergency caesareans in migrant women living in HICs.
  
  
  CONCLUSIONS
  "Potentially preventable" emergency caesareans in migrant women are likely due to several modifiable, interrelated factors pre-pregnancy, during pregnancy and during labour. Migration itself is a determinant and also shapes other determinants. Complications and ineffective labour progress and/or foetal distress and ultimately the decision to perform an emergency caesarean may be the result of poor health (i.e., physiological effects), lack of support and disempowerment (i.e., psychological effects) and sub-optimal care.
  
  
  CONCLUSIONS
  Understanding the direct and indirect effects of migration on emergency caesarean is crucial so that targeted strategies can be developed and implemented for reducing unnecessary caesareans in this vulnerable population.
authors.affiliation: Ingram School of Nursing, McGill University, Montreal, Quebec, Canada. Electronic address: lisa.merry@mail.mcgill.ca.
authors.forename: Lisa
authors.initials: L
authors.lastname: Merry
authors.affiliation: Ingram School of Nursing, McGill University, Montreal, Quebec, Canada; Women's Health Mission, McGill University Health Centre (MUHC), Montreal, Quebec, Canada.
authors.forename: Sonia
authors.initials: S
authors.lastname: Semenic
authors.affiliation: Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada.
authors.forename: Theresa W
authors.initials: TW
authors.lastname: Gyorkos
authors.affiliation: Centre hospitalier universitaire de Sherbrooke (CHUS) Research Centre, Sherbrooke, Quebec, Canada; Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Fraser
authors.affiliation: Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia.
authors.forename: Rhonda
authors.initials: R
authors.lastname: Small
authors.affiliation: Ingram School of Nursing, McGill University, Montreal, Quebec, Canada; The Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Quebec, Canada.
authors.forename: Anita J
authors.initials: AJ
authors.lastname: Gagnon
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data*; D003469:Culture; D036861:Delivery, Obstetric; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D036801:Parturition; D011247:Pregnancy; D011295:Prenatal Care; D012307:Risk Factors; D012959:Socioeconomic Factors
keywords: Determinants of health; Emergency caesarean; Framework; International migration; Women's health