Migrant women’s views and experiences of caesarean section

Background

Caesarean section rates have been increasing globally over the last two decades and in some countries is now the most common mode of birth. Incidence rates within the United Kingdom have mirrored this increasing trend. There is growing concern of the number of procedures being undertaken and it is accepted that interventions are required to reduce unnecessary procedures. This requires gaining understanding of the complex factors that contribute towards decision making surrounding caesarean birth, as well as any disparities and inequalities that may exist with vulnerable populations such as migrants.

Aim

The primary aim of this thesis is to address the research question “What is the incidence, perceptions, and experiences of caesarean birth for migrant women in the United Kingdom?”

Methods

A systematic review of caesarean birth in migrants in Europe was undertaken to inform development of an emergent sequential exploratory mixed methods study. A quantitative phase carried out logistic regression utilising secondary data from the Born in Bradford cohort study to determine incidence of caesarean birth of migrant populations in comparison to UK born counterparts. Results from this analysis enabled identification of a population of interest (Somali women) on which to focus the subsequent qualitative phase of the study. An additional literature review and meta-analysis focusing on caesarean incidence in the Somali diaspora was performed. In the qualitative phase, semi-structured interviews were conducted with Somali women to explore their views and experiences of caesarean birth in the UK.

Key findings

Findings from the research programme as a whole were integrated narratively. The quantitative analysis determined variation in the incidence rates between different migrant populations compared to UK born women. Women from SubSaharan Africa were found to have higher rates of caesarean birth and so it was decided to focus on a population from a Sub-Saharan African country, Somalia. Literature review and meta-analysis focusing on Somali women indicates that globally, this migrant population have significantly higher incidence rates of caesarean birth compared to host country counterparts and that this higher rate is largely attributed to significantly higher rates of emergency procedures. Interviews with Somali women indicated a strong preference for vaginal birth with an acceptance for caesarean when medically indicated. Culture, family, and community were found to play a key role in influencing women’s knowledge and views of caesarean birth. Communication and interactions with healthcare professionals impacted on birth experience. This had specific implications for information and experiences relating to caesarean birth.

Conclusion

Consensus needs to be reached in relation to definitions within this field of research to improve homogeneity of studies for generating an accurate picture of global diaspora specific to country of origin rather than regional population groupings. Interventions are required to enhance cultural competency of healthcare professionals and improve the experience of women. These should seek to build collaborative partnerships with local communities.

Original contribution

This work makes an original contribution to knowledge through providing data of caesarean incidence rates of migrants in relation to the UK. The views and experiences of caesarean section amongst Somali migrant women have been explored in the UK context to contribute to knowledge of the Somali diaspora.