Labor Management and Mode of Delivery Among Migrant and Spanish Women: Does the Variability Reflect Differences in Obstetric Decisions According to Ethnic Origin?

Based on previous findings showing both better birth outcomes in migrant than in Spanish women and different rates of medical
intervention according to mother’s origin, we hypothesize that mode of delivery decisions to solve similar problems differ
according to ethnic origin. Ethnic differences for maternal characteristics, medical intervention, and mode of delivery were
evaluated in 16,589 births from a Maternity Hospital in Madrid (Spain). Multinomial logistic regression analysis was used
to evaluate the effect of mother’s ethnic origin on the mode of delivery, adjusting for mother’s age, parity, gestational
age, birth weight, and epidural anesthesia. Compared with the Spanish mothers, the risk of having a Caesarean section is significantly
higher in Latin Americans and significantly lower for the Chinese. Both low birth weight and macrosomic deliveries are at
higher risk for Caesarean section. The interventionist system characterizing Spain is being extended to all ethnic groups
and, at the same time, different medical interventions are applied to similar problems depending on women’s ethnic origin.
Obstetric interventions might be contributing to the increasing trend of low birth weight and late preterm/early full term
deliveries (37–38 weeks) observed in Spain. Behavioral and cultural values of the women and of the health care providers may
contribute to systematic differences in labor management and mode of delivery.