Maternal race and immigration linked to obstetric trauma: higher risk among Asian mothers and Black immigrant/refugee mothers

(Press-News.org) Asian parents experience a 1.5-fold higher rate of obstetric trauma than White parents, and Black economic immigrant and refugee parents have a 20% to 30% higher risk, according to new research published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.250633.

Obstetric trauma, defined as severe injury to the perineum, cervix, vagina, or surrounding area during childbirth, occurs in 4% to 6% of vaginal births in Canada and can lead to short-term complications, such as hemorrhage and infection, and long-term complications such as bowel incontinence and pelvic floor problems.

In this large study, researchers aimed to understand the intersectional relationships between race, immigration factors, and obstetric trauma. It included 487 158 births, with data on race obtained through prenatal screening records in Ontario between April 1, 2012, and March 31, 2021. Of the total births, 6% (29 733) were to Black parents, 26% (126 744) were to Asian parents, 61% (297 292) were to White parents, and 5% (22 235) were to parents of other races. The majority of births (87%) were spontaneous, 10% involved vacuum extraction, and 3% involved forceps. The risk of obstetric trauma was higher in Asian mothers (7.5%) and lower in Black mothers (3%) than White mothers (5%); however, the lower rate of obstetric trauma was not found uniformly among all Black mothers.

“While higher rates of obstetric trauma were found among Asian mothers across the board, we found variations in the relationship between maternal race and obstetric trauma by immigration class among Black mothers,” says Dr. Giulia Muraca, senior author and a perinatal epidemiologist and an associate professor in the Departments of Obstetrics and Gynecology and Health Research Methods, McMaster University, Hamilton, Ontario. “Black immigrants who were refugees or economic class immigrants had 20% to 30% higher rates of obstetric trauma than White non-immigrants, while this was not seen among Black family class, other immigrant class, and non-immigrant Black mothers.”

“We also found that immigrants with shorter duration of residence had higher initial risk of obstetric trauma, and the risk declined with increasing duration in Canada. This could be explained by better prenatal care, earlier interventions, informed decision making, or reduced language barriers with increasing time in Canada.”

The authors suggest this research could be useful to policy-makers and health care systems.

“These findings could inform policies to reduce disparities earlier after immigrants arrive in Canada, such as targeted prenatal care programs for newcomers, and the development of culturally competent and equitable care strategies,” they conclude.

END