Mothers' Level of Education and Childbirth Interventions: A Population-based Study in Flanders, Northern Belgium

H Cammu, G Martens, Marc Keirse

    Research output: Contribution to journalArticlepeer-review

    18 Citations (Scopus)

    Abstract

    Background: Interventions to influence the time and way to be born have been a global concern for decades. Yet, limited information is available on what drives these interventions and their variation in frequency among countries, institutions, and practitioners. The objective of this study was to examine to what extent first-time mothers' educational achievement contributes to the frequency of childbirth interventions. Methods: Childbirth interventions, including induction of labor, cesarean section, instrumental delivery, and epidural analgesia, registered by the Flemish Study Center for Perinatal Epidemiology for Belgian-born nulliparous women from 1999 to 2006, were linked to the level of maternal education, recorded by the Belgian civil birth registration. Education was divided into four levels based on the highest diploma attained and adjusted for marital and occupational status. Results: Frequencies of all interventions were inversely related to the level of maternal education. The effect remained after adjustment for birth year, maternal age, marital status, occupation, infant birthweight, gestational age, assisted conception, and type of hospital. Effect sizes between highest and lowest levels of education were relatively small for operative (31% vs 36%) and instrumental vaginal birth (20.7% vs 22.3%) compared with "initiated delivery" (defined as labor induction and prelabor cesarean section; 30.2% vs 40.3%) and epidural analgesia (66.8% vs 78.0%). The educational gradient in initiated delivery occurred at all gestational ages, contributing to lower gestational age and lower birthweight of term infants with decreasing levels of education. Conclusions: In an affluent society with universal and equitable access to maternity care, the more educated women are, the more likely they are to have a spontaneous labor and spontaneous birth without intervention. (BIRTH 38:3 September 2011)

    Original languageEnglish
    Pages (from-to)191-199
    Number of pages9
    JournalBirth - Issues in Perinatal Care
    Volume38
    Issue number3
    DOIs
    Publication statusPublished - Sep 2011

    Bibliographical note

    Copyright:
    Copyright 2011 Elsevier B.V., All rights reserved.

    Keywords

    • Birthweight
    • Cesarean section
    • Education
    • Epidural analgesia
    • Gestational age
    • Instrumental delivery
    • Labor induction
    • Maternal education
    • Natural childbirth
    • Nulliparity
    • Socioeconomic trends

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