| Summary: | 碩士 === 中國醫藥大學 === 醫務管理學研究所碩士班 === 94 === Aim: In Taiwan, today there are two major issues in obstetric medical care, the increase of immigrant mothers and the high prevalence of cesarean rate. There are potential overuse of medical resources in excess cesarean rate, whilst low cesarean rate may indicate insufficiency of medical care. The aim of this research is to survey the variations of perinatal background and delivery modes between Taiwanese and immigrant mothers, and to identify factors that affect the choice of delivery modes among different ethnics.
Methods: Using semi-structured questionnaire and medical charts data review, we survey maternal women from a regional teaching hospital and a clinic in central Taiwan from May 2005 through March 2006. We collected data from 1465 mothers (including 1182 Taiwanese mothers, 76 mothers from mainland China and 207 mothers from Southeast Asia). Chi-square test and ANOVA were utilized to describe the background variations of the three ethnic groups, logistic regression was used to further analyze the influencing factors that affect the choice of delivery modes in different ethnic groups.
Results: The cesarean rate of Taiwanese, mainland China and Southeast Asia are 33.6%, 26.3% and 17.9% respectively, which demonstrated significant difference in their choice of delivery modes. Futher analysis of the characteristics including maternal physiological characters, infant characters, clinical delivery-related characters and socioeconomical backgrounds of these ethnic groups were preceded. The age, body weight and cesarean rate are higher in Taiwanese mothers, accompanied with better social, educational, economical backgrounds. There are no significant differences between maternal and neonatal outcomes.Further study of the influencing factors on cesarean rate difference revealed that nationality is not the direct influential factor, but higher age, body weight and previous cesarean numbers of Taiwanese mothers. The non-medical factors such as social and economical do not significantly affect the choice of delivery mode of different ethnic mothers.
Conclusion: Due to higher age, body weight, perinatal body weight gaining and previous cesarean numbers of Taiwanese mothers, the cesarean rate is significantly higher than other groups. The cesarean rates of the relatively younger and healthier immigrant mothers are significantly lower, and also consumed less medical resources. The perinatal health outcome in three different groups are all in good condition. The present study revealed that in the medical decision making process of mother and obstetrician, nationality, social and economic factors contribute no significant effect on the selection of cesarean delivery. This result demonstrates the perinatal medical care accessibility of nowaday Taiwan is acceptable and adequate. Accordingly, promoting of virginal birth after cesarean delivery, encouragement of birth at younger years, avoiding elder maternity, proper control of body weight are all effective strategies to reduce the excess cesarean rate in Taiwan.
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