Cesarean and VBAC Rates among Immigrant vs. Native-Born Women –

Objective: Cultural and ethnic roots impacts women's fertility and delivery preferences. This study investigated whether the likelihood of cesarean delivery and vaginal delivery after cesarean (VBAC) varies by maternal national origin. Design: Nation-wide, population-based, observational study using secondary data. Setting: Taiwan, ROC. Population: All 392,246 singleton live births (≥500g; ≥20 weeks) to native Taiwanese, Vietnamese and mainland Chinese-born mothers Methods: De-identified nation-wide birth certificate data for 2006-07, yielding analytic samples as follows: for overall cesarean likelihood 392,246 births, primary cesarean 336,766 (excluding repeat cesarean and VBAC), and VBAC 55,480 births (excluding primary cesarean and vaginal births without previous cesarean). Main outcome: Overall cesarean, primary cesarean and VBAC odds of Vietnamese and Chinese immigrant mothers relative to Taiwanese using multiple regression analyses to adjust for maternal and neonatal characteristics, paternal age, institutional setting, and major obstetric complications. Results: Unadjusted overall cesarean, primary cesarean, and VBAC rates were 33.9%, 23.0% and 4.0% for Taiwanese, 27.6%, 20.1% and 5.0% for mainland Chinese, and 19.3%, 13.9 and 6.1% for Vietnamese respectively. Adjusted for confounders, Vietnamese mothers were less likely than Taiwanese to have overall and primary cesarean delivery (OR=0.59 and 0.58 respectively), followed by Chinese mothers (both ORs=0.90 relative to native-born Taiwanese). Vietnamese were most likely to have successful VBAC (OR=1.58), followed by Chinese (OR=1.25). Conclusions: Immigrant Vietnamese and Chinese mothers have lower odds of cesarean and higher VBAC odds than native-born Taiwanese, consistent with lower cesarean rates prevailing in their home countries (Vietnam 10.1%; mainland China 20% - 50% rural and urban respectively).