Ethnic variation between white European women in labour outcomes in a setting in which the management of labour is standardised-a healthy migrant effect?

Abstract

Objective: To test the hypothesis that women from Eastern European countries have lower caesarean delivery rates and higher spontaneous labour rates relative to Irish women in a setting in which the management of labour is standardised.

Design: A retrospective review of prospectively collected data.

Setting: Tertiary referral centre, Dublin, Ireland.

Population: All Irish and Eastern European term nulliparous women who laboured and delivered in 2008.

Methods: A comparison of labour outcomes between women from Ireland and women from Eastern European countries.

Main outcome measures: The principal outcomes measured were the gestational age at onset of labour, whether labour was spontaneous or induced, the need for oxytocin augmentation, duration of labour, mode of delivery, epidural use and birthweight.

Results: Of 2556 Irish (n = 2041) and Eastern European (n = 511) term cephalic singleton labours in the calendar year 2008, women from Eastern Europe were significantly more likely to labour spontaneously (74.6% versus 65.9%, P < 0.001), required less epidural analgesia (68.4% versus 59.7%) and were significantly less likely to require delivery by caesarean section (8.6% versus 15.7%, P < 0.001) than Irish women. This is despite no significant difference between the two groups with regard to mean birthweight (3581 g versus 3569 g, P = 0.6) or macrosomia (birthweight over 4000 g) (18% versus 16%, P = 0.4). There were significant differences in maternal age at delivery (27.2 years versus 29.2 years, P < 0.001) and body mass index (BMI) (24.1 kg/m² versus 25.4 kg/m², P < 0.001) between the two groups.

Conclusion: These findings confirm our hypothesis that economic migrants from Eastern European countries exhibit a so-called 'healthy migrant effect' in terms of obstetric outcomes.