Adverse outcomes of labour in public and private hospitals in Australia: a population‐based descriptive study

Robson, Stephen; Laws, Paula; Sullivan, Elizabeth

doi:10.5694/j.1326-5377.2009.tb02521.x

Cited by 42 publications

(58 citation statements)

References 30 publications

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“…In a recent publication we showed that the rate of caesarean section had increased in both the private and public sector in the past decade in low-risk women 9. It has been argued in a previous publication that these high intervention rates in the private sector led to better perinatal outcomes than in the public sector 2. This publication received significant criticism in letters to the editor3 16 17 for several methodological flaws, including most significantly the failure to adjust for low-birth weight, inadequate ascertainment of congenital abnormalities and failure to look at perinatal morbidity.…”

Section: Discussionmentioning

confidence: 89%

“…The remaining 71% (n=204 399) of women gave birth in public hospitals in Australia. Women who are privately insured have been reported to have better maternal and perinatal outcomes compared to women who give birth in public hospitals as public patients2; but it has been argued that these women tend to be less socioeconomically disadvantaged and healthier3 and therefore might be expected to have better outcomes. Arguments about the impact of private status on health outcomes are in reality complex.…”

Section: Introductionmentioning

confidence: 99%

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Rates of obstetric intervention and associated perinatal mortality and morbidity among low-risk women giving birth in private and public hospitals in NSW (2000–2008): a linked data population-based cohort study

Dahlen

Tracy

et al. 2014

BMJ Open

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ObjectivesTo examine the rates of obstetric intervention and associated perinatal mortality and morbidity in the first 28 days among low-risk women giving birth in private and public hospitals in NSW (2000–2008).DesignLinked data population-based retrospective cohort study involving five data sets.SettingNew South Wales, Australia.Participants691 738 women giving birth to a singleton baby during the period 2000–2008.Main outcome measuresRates of neonatal resuscitation, perinatal mortality, neonatal admission following birth and readmission to hospital in the first 28 days of life in public and private obstetric units.ResultsRates of obstetric intervention among low-risk women were higher in private hospitals, with primiparous women 20% less likely to have a normal vaginal birth compared to the public sector. Neonates born in private hospitals were more likely to be less than 40 weeks; more likely to have some form of resuscitation; less likely to have an Apgar <7 at 5 min. Neonates born in private hospitals to low-risk mothers were more likely to have a morbidity attached to the birth admission and to be readmitted to hospital in the first 28 days for birth trauma (5% vs 3.6%); hypoxia (1.7% vs 1.2%); jaundice (4.8% vs 3%); feeding difficulties (4% vs 2.4%) ; sleep/behavioural issues (0.2% vs 0.1%); respiratory conditions (1.2% vs 0.8%) and circumcision (5.6 vs 0.3%) but they were less likely to be admitted for prophylactic antibiotics (0.2% vs 0.6%) and for socioeconomic circumstances (0.1% vs 0.7%). Rates of perinatal mortality were not statistically different between the two groups.ConclusionsFor low-risk women, care in a private hospital, which includes higher rates of intervention, appears to be associated with higher rates of morbidity seen in the neonate and no evidence of a reduction in perinatal mortality.

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Rates of obstetric intervention and associated perinatal mortality and morbidity among low-risk women giving birth in private and public hospitals in NSW (2000–2008): a linked data population-based cohort study

Dahlen

Tracy

et al. 2014

BMJ Open

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“…Public hospitals are known to serve a disproportionately larger share of patients of relatively low socio-economic status [30]. Women giving birth in public hospitals have been found to be younger, a higher proportion are first births, a greater proportion smoke, and more women present with medical conditions such as hypertension and diabetes [31]. The Health Districts of the study region are known to have higher proportions of socio-economic disadvantage and more people with non-English speaking backgrounds than the national average [9].…”

Section: Discussionmentioning

confidence: 99%

Environments For Healthy Living (EFHL) Griffith birth cohort study: characteristics of sample and profile of antenatal exposures

et al. 2012

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BackgroundThe Environments for Healthy Living (EFHL) study is a repeated sample, longitudinal birth cohort in South East Queensland, Australia. We describe the sample characteristics and profile of maternal, household, and antenatal exposures. Variation and data stability over recruitment years were examined.MethodsFour months each year from 2006, pregnant women were recruited to EFHL at routine antenatal visits on or after 24 weeks gestation, from three public maternity hospitals. Participating mothers completed a baseline questionnaire on individual, familial, social and community exposure factors. Perinatal data were extracted from hospital birth records. Descriptive statistics and measures of association were calculated comparing the EFHL birth sample with regional and national reference populations. Data stability of antenatal exposure factors was assessed across five recruitment years (2006–2010 inclusive) using the Gamma statistic for ordinal data and chi-squared for nominal data.ResultsAcross five recruitment years 2,879 pregnant women were recruited which resulted in 2904 live births with 29 sets of twins. EFHL has a lower representation of early gestational babies, fewer still births and a lower percentage of low birth weight babies, when compared to regional data. The majority of women (65%) took a multivitamin supplement during pregnancy, 47% consumed alcohol, and 26% reported having smoked cigarettes. There were no differences in rates of a range of antenatal exposures across five years of recruitment, with the exception of increasing maternal pre-pregnancy weight (p=0.0349), decreasing rates of high maternal distress (p=0.0191) and decreasing alcohol consumption (p<0.0001).ConclusionsThe study sample is broadly representative of births in the region and almost all factors showed data stability over time. This study, with repeated sampling of birth cohorts over multiple years, has the potential to make important contributions to population health through evaluating longitudinal follow-up and within cohort temporal effects.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12610000931077

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“…Evidence suggests that publicly insured women are generally less healthy and in more need of health care services than other women [4-12]. This appears to be related to poor outcomes for infants born at term in Australia [13]. Eliminating the demographic differences between publicly insured and privately insured women would therefore seem important in order to investigate whether there are true differences in neonatal outcomes between these groups of women.…”

Section: Introductionmentioning

confidence: 99%

Neonatal outcomes after preterm birth by mothers’ health insurance status at birth: a retrospective cohort study

Einarsdóttir

Haggar

Langridge

et al. 2013

BMC Health Serv Res

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BackgroundPublicly insured women usually have a different demographic background to privately insured women, which is related to poor neonatal outcomes after birth. Given the difference in nature and risk of preterm versus term births, it would be important to compare adverse neonatal outcomes after preterm birth between these groups of women after eliminating the demographic differences between the groups.MethodsThe study population included 3085 publicly insured and 3380 privately insured, singleton, preterm deliveries (32–36 weeks gestation) from Western Australia during 1998–2008. From the study population, 1016 publicly insured women were matched with 1016 privately insured women according to the propensity score of maternal demographic characteristics and pre-existing medical conditions. Neonatal outcomes were compared in the propensity score matched cohorts using conditional log-binomial regression, adjusted for antenatal risk factors. Outcomes included Apgar scores less than 7 at five minutes after birth, time until establishment of unassisted breathing (>1 minute), neonatal resuscitation (endotracheal intubation or external cardiac massage) and admission to a neonatal special care unit.ResultsCompared with infants of privately insured women, infants of publicly insured women were more likely to receive a low Apgar score (ARR = 2.63, 95% CI = 1.06-6.52) and take longer to establish unassisted breathing (ARR = 1.61, 95% CI = 1.25-2.07), yet, they were less likely to be admitted to a special care unit (ARR = 0.84, 95% CI = 0.80-0.87). No significant differences were evident in neonatal resuscitation between the groups (ARR = 1.20, 95% CI = 0.54-2.67).ConclusionsThe underlying reasons for the lower rate of special care admissions in infants of publicly insured women compared with privately insured women despite the higher rate of low Apgar scores is yet to be determined. Future research is warranted in order to clarify the meaning of our findings for future obstetric care and whether more equitable use of paediatric services should be recommended.

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Adverse outcomes of labour in public and private hospitals in Australia: a population‐based descriptive study

Cited by 42 publications

References 30 publications

Rates of obstetric intervention and associated perinatal mortality and morbidity among low-risk women giving birth in private and public hospitals in NSW (2000–2008): a linked data population-based cohort study

Rates of obstetric intervention and associated perinatal mortality and morbidity among low-risk women giving birth in private and public hospitals in NSW (2000–2008): a linked data population-based cohort study

Environments For Healthy Living (EFHL) Griffith birth cohort study: characteristics of sample and profile of antenatal exposures

Neonatal outcomes after preterm birth by mothers’ health insurance status at birth: a retrospective cohort study

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