The Brazilian preference?

4753658072_3816f74c0d_nWhat happens when a woman emigrates to a foreign country and then gives birth? Is her birth experience more likely to conform to the country she comes from, or the one she moves to?

For example, is an immigrant woman more likely to have a cesarean birth than a native-born woman, or less? How big a role do the cultural norms and expectations she brings with her from her home country play in determining mode of delivery?

Studies of immigrant birth experiences have been mixed to date. Immigrants do tend to have higher cesarean rates than natives, but interpretations of such findings are often complicated by things like language barriers and the difficulties new arrivals may have in accessing timely maternity care. Teasing out the effects of culture can be tricky.

A Portuguese article just published in the journal PLOS ONE helps to clarify this issue. The study compares cesarean rates between native-born and immigrant Brazilian women in northern Portugal. Two major potential confounders are quickly dealt with: the two groups of women both spoke Portuguese, which eliminates language barrier as a source of cesarean-inducing miscommunication, and all the women were drawn from five public hospitals, so that the care they received was more or less uniform.

The authors found that Brazilian immigrant women had a 50% higher cesarean rate than did native-born Portuguese women (48.4% vs. 32.1%), a difference that persisted even after controlling for such things as demographic, medical and obstetric risk factors. In fact, the cesarean rate for Brazilian immigrants was nearly identical to the overall cesarean rate in Brazil itself.

What explains the native-immigrant difference? The authors speculate it has much to do with attitudes about childbirth that the women brought with them from Brazil:

“This extremely high prevalence [of cesarean birth] seems to be a cultural consequence of attitudes towards labor and the perception of obstetric care among Brazilian women. The majority of Brazilian women perceive cesarean as the most adequate mode of delivery and as a symbol of high social status.”

In other words, culture strongly influences mode of delivery, even far from home. A woman raised to see cesarean birth as a desirable norm is much more likely to end up having one.

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