Obstetric interventions among native and migrant women: a survey of episiotomy in Portugal Elsa Lorthe E Lorthe 1 , C Teixeira 1,2 , T Rodrigues 1,3,4 , H Barros 1,4 1 EPIUnit, Instituto de Sau ´ de Pu ´ blica, Universidade do Porto, Porto, Portugal 2 Polytechnic Institute of Braganc ¸ a, Braganc ¸ a, Portugal 3 Department of Gynecology and Obstetrics, S. Joa ˜ o Hospital Center, Porto, Portugal 4 Departamento de Cie ˆ ncias de Sau ´ de Pu ´ blica e Forenses, Faculdade de Medicina da Universidade do Porto, Porto, Portugal Contact: elsa.lorthe@gmail.com Introduction: It is unclear whether migrant women experience worse pregnancy outcomes than native women. A better comprehen- sion of obstetric care provision, including controversial interventions such as episiotomy, is important to improve equity of service provision, overall maternal and neonatal health and to support evidence-informed perinatal health policy-making. We aimed to determine if migrant and native women giving birth vaginally have different risks of episiotomy and if the risk differs by migrant sub-groups. Methods: This study is based on a cross-sectional survey of foreign-born women with a random sample of native women, implemented in 32 public maternity units in mainland Portugal. We included 3583 women with vaginal delivery. Migrant status was defined by the woman’s country of birth (migrants, born abroad, vs natives, born in Portugal), then as subgroups of migrants from Brasil, Portuguese-speaking African countries (PSAC) and non Portuguese-speaking countries vs natives. The association between migrant status and episiotomy was assessed using multilevel logistic regression models, stratified by delivery mode, and adjusted for main risk factors of episiotomy. Results: The overall frequencies of episiotomy were 52.6% and 48.2% among the 1707 natives and the 1876 migrants, respectively (p = 0.01). With spontaneous delivery, migrant women had decreased odds of having an episiotomy (adjusted OR 0.70 [95% CI 0.58-0.83]), especially those from PSAC (aOR 0.57 [0.46-0.71]). However, with instrumental delivery, migrant women had increased odds of episiotomy (aOR 2.47 [95% CI 1.50-4.07]), especially those from Brasil (aOR 3.24 [1.18-8.92]) and non Portuguese-speaking countries (aOR 3.75 [1.82- 7.71]). Conclusions: These results suggest non-medically justified differential care during childbirth and highlight the importance of developing evidence-based recommendations for episiotomy use, in a country with a high frequency of medical intervention during delivery. Key messages:  Portugal displays a high frequency of medical interventions during delivery, including episiotomy, highlighting the need for developing evidence-based recommendations.  Migrant and native women have different risks of episiot- omy, suggesting non-medically justified differential care. Caesarean section and neonatal outcomes among women of migrant origin in Finland Kalpana Bastola K Bastola 1 , P Koponen 2 , M Gissler 3,4 , T Kinnunen 1 1 Unit of Health Sciences, Tampere University, Tampere, Finland 2 Department of Health, National Institute of Health and Welfare, Helsinki, Finland 3 Department of Information Services, National Institute of Health and Welfare, Helsinki, Finland 4 Department of Neurobiology, Karolinska Institute, Stockholm, Sweden Contact: kalpana.bastola@tuni.fi Background: In Finland, limited information is available on neonatal disparities among migrant origin women. We investigated differences in caesarean section and neonatal outcomes between migrant and Finnish origin women in Finland. Methods: National data from the Medical Birth Register of Finland included information on the most recent singleton birth of all women (n = 382 233) between January 2004 and December 2014. We categorized women into nine regional categories based on their country of origin by linked population data from Statistics Finland. Women with Finnish origin were used as a reference group. Our main statistical method was logistic regression analyses adjusted for age, socio-economic status, pre-pregnancy body mass index, gestational age, parity, marital status, smoking during pregnancy, and ponderal index. Results: Compared with Finnish women, Sub-Saharan African women had higher odds for caesarean sections OR 2.14 (95% CI 1.96, 2.33), preterm births OR 1.22 (95% CI 1.0, 1.43), low 5 minutes Apgar score OR 3.73 (95% CI 3.09, 4.49), and intensive care unit care OR 1.39 (95% CI 1.24, 1.56) for newborns. South Asian and East Asian women were at increased risk for caesarean births OR 1.52 (95% CI 1.36, 1.71) and OR 1.19 (95% CI 1.10, 1.28) respectively, preterm birth OR 1.46 (95% CI 1.20, 1.77), and OR 1.28 (95% CI 1.13, 1.46) and low 5 minutes Apgar score OR 2.06 (95% CI 1.55, 2.76), and OR 1.36 (95% CI 1.11, 1.67) compared with Finnish women. Middle Eastern and Latin America/Caribbean women had higher odds for caesarean births OR 1.13 (95% CI 1.02, 1.24), and OR 1.66 (95% CI 1.39, 1.97) respectively and low 5 minutes Apgar score OR 1.69 (95% CI 1.34, 2.14) and OR 2.12, (95% CI 1.37, 3.26) compared with Finnish women. Conclusions: Groups of women with higher risk for caesarean section and poor neonatal outcomes were identified and they may need more attention in maternal and child health services. Key messages:  Women from Sub-Saharan African, East Asian and South Asian origin had an elevated risk for most of the poor obstetric outcomes compared with Finnish women.  Women from East Asian and Russian/former USSR countries had lower risk for caesarean section and newborns care in intensive care unit compared with Finnish women. 8.I. Improving vaccine confidence: actions and outcomes Misconceptions and lack of vaccine confidence: even First Responders are not spared Matteo Ricco ` M Ricco ` 1 , L Vezzosi 2 , F Balzarini 3 , AG Mezzoiuso 3 , L Veronesi 4 , ME Colucci 4 , C Signorelli 3 1 Dipartimento di Sanita ` Pubblica, Azienda USL di Reggio Emilia, Reggio Emilia, Italy 2 Direzione Sanitaria, ASST di Cremona, Cremona, Italy 3 Scuola di Specializzazione in Igiene e Sanita ` Pubblica, Universita ` San Raffaele, Milan, Italy 4 Dipartimento Medico Chirurgico, Universita ` degli Studi di Parma, Parma, Italy Contact: mricco2000@gmail.com Introduction: First Responders (FR) are front-line healthcare workers potentially exposed to different infectious agents. Characterizing their knowledge, attitudes and practices 12th European Public Health Conference 2019–01: Parallel Programme 229 Downloaded from https://academic.oup.com/eurpub/article-abstract/29/Supplement_4/ckz185.625/5624682 by guest on 02 July 2020