The Brazilian Preference: Cesarean Delivery among Immigrants in Portugal

Objective: To evaluate how the country of origin affects the probability of being delivered by cesarean section when giving birth at public Portuguese hospitals. Study Design: Women delivered of a singleton birth (n = 8228), recruited from five public level III maternities (April 2005-August 2006) during the procedure of assembling a birth cohort, were classified according to the country of origin and her migration status as Portuguese (n = 7908), non-Portuguese European (n = 84), African (n = 77) and Brazilian (n = 159). A Poisson model was used to evaluate the association between country of birth and cesarean section that was measured by adjusted prevalence ratio (PR) and respective 95% confidence intervals (95%CI). Results: The cesarean section rate varied from 32.1% in non-Portuguese European to 48.4% in Brazilian women (p = 0.008). After adjustment for potential confounders and compared to Portuguese women as a reference, Brazilian women presented significantly higher prevalence of cesarean section (PR = 1.26; 95%CI: 1.08-1.47). The effect was more evident among multiparous women (PR = 1.39; 95%CI: 1.12-1.73) and it was observed when cesarean section was performed either before labor (PR = 1.43; 95%CI: 0.99-2.06) or during labor (PR = 1.30; 95%CI: 1.07-1.58). Conclusions: The rate of cesarean section was significantly higher among Brazilian women and it was independent of the presence of any known risk factors or usual clinical indications, suggesting that cultural background influences the mode of delivery overcoming the expected standard of care and outcomes in public health services.