We recruited women delivering in three secondary and tertiary care maternity hospitals of Berlin/Germany ((1) the Virchow Campus site of the Charité University Hospital, (2) the Vivantes Klinikum am Urban, and (3) the Vivantes Klinikum Neukölln) in a 12-month period 2011/12 (n = 8157). Minors (n = 105, 1.3%), tourists not resident in Germany (n = 24, 0.3%), women terminating a pregnancy, and women with miscarriages and stillbirths (fetal death in utero ascertained at hospital admission and before onset of labor, n = 106, 1.3%) were excluded. It was not possible to contact 363 women despite multiple attempts. Of the remaining 7559 women 381 declined to participate. We conducted face-to-face interviews and linked them with highly standardized obstetric process and outcome data from hospital databases. Linkage of available interview data with obstetric process and outcome data failed in 72 cases. Six women did not consent to the linkage of data sources. In total, 7100 women participated (response rate of 89.6%). This corresponded to 7334 birth data records because of twin and triplet births.
For the analysis presented here, we considered only nulliparous women with vertex pregnancies and singleton birth, 37th week of gestation onwards. Women with elective cesarean delivery were excluded as they are not informative for our study question. We further restricted the sample to women with own migration experience (1st generation immigrants). Migrant women are a heterogeneous group. Health differences in this group might be larger than between migrant and non-migrant women. For this reason we selected women originating from Turkey and Lebanon (the two largest and only immigrant groups that allow separate analysis) and to women without a migration history (non-immigrant women). Also, 63 women without data on cervical dilatation were removed from analyses (see Fig.1 ).![]()
In the original study, interviews were conducted with each subject at two time points: on admission to the delivery room (T1) and on the second or third day postpartum in the maternity wards (T2). Questionnaires were available in German, Turkish, Kurdish, Arabic, and other languages. Translators were involved in case of language barriers. Nearly all women with migration background (193 of 205) were able to communicate with the obstetrician in German. For this analysis, only T1 data was used. Formally, the analyses reported here are secondary analyses as the original study question related to pregnancy outcomes such as frequeny of cesarean deliveries [20 (link)].
For the analysis presented here, we considered only nulliparous women with vertex pregnancies and singleton birth, 37th week of gestation onwards. Women with elective cesarean delivery were excluded as they are not informative for our study question. We further restricted the sample to women with own migration experience (1st generation immigrants). Migrant women are a heterogeneous group. Health differences in this group might be larger than between migrant and non-migrant women. For this reason we selected women originating from Turkey and Lebanon (the two largest and only immigrant groups that allow separate analysis) and to women without a migration history (non-immigrant women). Also, 63 women without data on cervical dilatation were removed from analyses (see Fig.
Flowchart of case recruitment, Berlin Perinatal study, 2011/12
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