Migrant Women's C-Section Decision-Making Experiences in Edmonton, Alberta

• Author / Creator

  Sivananthajothy, Priatharsini

• Background: Globally caesarean section (C-section) rates are exceeding recommended ranges, placing women at higher risk for complications. Evidence suggests migrant women have higher C-section rates compared to Canadian-born women. Communication barriers including the lack of ability to negotiate have been cited as potential contributing factors. This leads us to question the degree to which women, especially migrants participate in decision-making. Moreover, the complexities of patient-provider interactions have yet to be explored thoroughly in migrant populations, especially in the context of labour and delivery. Given this, our study aimed to understand: (i) to what extent do migrant women participate in both planned C-section decision-making and decisions during labour and delivery, including emergency C-sections and (ii) whether these experiences differ from that of Canadian-born women.
  Methods: A qualitative study using a focused ethnographic approach was conducted at a teaching hospital in Edmonton over a ten-month period. Migrant (N=64) and Canadian-born women (N=27) who had a higher risk of undergoing a C-section were included. Data were collected through observation of prenatal appointments, labour and delivery observations and postpartum in-depth interviews. Written informed consent was obtained from all participants and ethics approval was received from the University of Alberta.
  Results: Our findings revealed the planned C-section decision-making process and participation experiences during labour and delivery were similar between both groups of women. Migrant and Canadian-born women were the primary decisions-makers for most planned C-sections. While both groups’ decisions were based on medical factors, socio-cultural factors such as the lack of social support had a larger effect on migrant women’s decisions. Specifically, a group of migrant women chose to have planned C-sections in order to plan their time away from work, arrange childcare and overcome their lack of support.
  Within the context of labour and delivery, participation experiences including barriers faced, were found to be similar between both migrant and Canadian-born women. Power imbalances prevented both groups from participating in decision-making. These included: the institutional authority of providers, lack of opportunity to participate, limited sharing of information and communication barriers specific to migrant women. However, ‘expert patients’ consisting of migrant and Canadian-born women maneuvered and overcame these power imbalances due to privileged knowledge of obstetrical interventions available and learned ability to exercise their patient rights.
  Conclusions: In order to support both migrant and Canadian-born women’s participation in labour and delivery decision-making, we recommend further training of healthcare providers to actively inform, and involve women. Improved provision of information on obstetrical care and patient rights will be important to ensure patients are equipped to engage in conversations with providers. Furthermore, there is a need to understand and fulfill the underlying socio-cultural needs which may inadvertently be contributing to the higher C-section rates experienced by migrant women in Canada.

• Subjects / Keywords

  • public health
  • maternity
  • immigrant health
  • migrant health
  • Cesarean section
  • power
  • patient-provider
  • decision-making
  • C-section
  • patient participation

• Graduation date

  Fall 2018

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/R3QF8K15S

• License

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