Rates for obstetric intervention among private and public patients in Australia: population based descriptive study

Roberts, Christine L.; Tracy, Sally; Peat, Brian

doi:10.1136/bmj.321.7254.137

Cited by 185 publications

(201 citation statements)

References 22 publications

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“…Nevertheless, previous population studies undertaken in Australia identified a similar very small proportion of childbearing women (approximately 2%) reported to have pre-existing medical conditions at the time of birth. 18 Women with a history of medical or obstetric problems are advised to transfer and give birth in maternity hospitals where specialist medical expertise is on hand. This would contribute to a more favourable result in the low volume hospitals.…”

Section: Discussionmentioning

confidence: 99%

General obstetrics: Does size matter? A population‐based study of birth in lower volume maternity hospitals for low risk women

Tracy

Sullivan

Dahlen

et al. 2005

BJOG

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Objective To study the association between volume of hospital births per annum and birth outcome for low risk women.Design Population‐based study using the National Perinatal Data Collection (NPDC).Setting Australia.Participants Of 750,491 women who gave birth during 1999–2001, there were 331,147 (47.14%) medically ‘low risk’ including 132,696 (40.07%) primiparae and 198,451 (59.93%) multiparae.Methods The frequency of each birth and infant outcome was described according to the size of the hospital where birth took place. We investigated whether unit size (defined by volume) was an independent risk factor for each outcome factor using public hospitals with greater than 2000 births per annum as a reference point.Main outcome measures Rates of intervention at birth and neonatal mortality for low risk women in relation to hospitals with <100, 100–500, 501–1000, 1001–2000 and >2001 births per annum.Results Neonatal death was less likely in hospitals with less than 2000 births per annum regardless of parity. For multiparous low risk women in hospitals of 100 and 500 births per annum compared with hospitals of >2000 births per annum the adjusted odds of neonatal mortality [adjusted odds ratio (AOR) 0.36; 99% confidence interval (CI) 0.14–0.93]. For low risk primiparous women in hospitals with less than 100 births per annum, there were lower rates of induction of labour (AOR 0.62; 99% CI 0.54–0.73); intrathecal analgesia/anaesthesia (AOR 0.34; 99% CI 0.28–0.42); instrumental birth (AOR 0.80; 99% CI 0.69–0.93); caesarean section after labour (AOR 0.59; 99% CI 0.49–0.72) and admission to a neonatal unit (AOR 0.15; 99% CI 0.10–0.22) and for low risk multiparous women in hospitals with less than 100 births per annum: induction (AOR 0.69; 99% CI 0.62–0.76); intrathecal analgesia/anaesthesia (AOR 0.32; 99% CI 0.29–0.36); instrumental birth (AOR 0.52; 99% CI 0.41–0.67); caesarean section after labour (AOR 0.41; 99% CI 0.33–0.52); and admission to a neonatal unit (AOR 0.09; 99% CI 0.07–0.12).Conclusions In Australia, lower hospital volume is not associated with adverse outcomes for low risk women.

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Section: Discussionmentioning

confidence: 99%

General obstetrics: Does size matter? A population‐based study of birth in lower volume maternity hospitals for low risk women

Tracy

Sullivan

Dahlen

et al. 2005

BJOG

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“…Situating childbirth within this medicalised paradigm designates birth as an illness, which results in high levels of intervention such as caesarean sections even for low risk healthy women (Roberts, Tracy, & Peat, 2000;Wagner, 1994). This hierarchical medical model, combined with institutional limitations on time and place, allow the woman little opportunity to form a relationship with midwives who are the primary attendants throughout her labour.…”

Section: Introductionmentioning

confidence: 99%

The impact of Childbirth experiences on women's sense of self: A review of the literature

Parratt

2002

The Australian Journal of Midwifery

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“…In contrast, these factors were associated with change out of public care. Obstetric interventions are higher for women receiving private care 13 and the perceived availability of interventions such as regional analgesia may be drivers in women choosing this maternity care. Other research indicates that women are more satisfied when they have continuity of maternity care provider (midwife or obstetrician)…”

Section: Discussionmentioning

confidence: 99%

“…Women seeking private care have been shown to be older and first -time mothers, less likely to have medical or obstetrical complications, non-cephalic presenting infants and twin pregnancies than women seeking public care. 13 It is possible that there are different motivations for changing from public to private care that may also be related to facilities. Three quarters of private care is provided in private hospital settings that may be perceived to be aesthetically more pleasing than public facilities.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with changes into public or private maternity care for a second pregnancy

Ford

Bentley²,

Morris³

et al. 2013

Aust. Health Review

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Objective. The aim of this study was to determine whether outcomes in a first pregnancy were associated with changes into and out of public maternity care.Methods. The study population included 155,492 women with 1 st and 2 nd sequential singleton births, 2000-2009 in NSW. Analyses were stratified by whether obstetric care for the first birth involved private or public maternity care. Interventions, infant and maternal outcomes were assessed as predictors of a change in care. Adjusted odds ratios (aOR) for changing care were obtained from logistic regression using backwards elimination.Results. Similar proportions of women changed from private to public care between first and second births, (9.6% compared to 9.4% public to private, P=0.10). While interventions (operative delivery, epidural) and outcomes (low Apgar, preterm birth, perinatal death, postpartum haemorrhage, perineal tear and severe maternal morbidity) were all associated with changes from public to private care, only poor infant condition (aOR 1.39, 1.15-1.68) was associated with a change from private to public care.Conclusions. The majority of women had consistent care type for both births. This may indicate women are generally satisfied with care, they rationalize that their first birth care was optimal or they value continuity of carer across pregnancies. What is known about the topic?There is some evidence to suggest that interventions and outcomes of one pregnancy are associated with changes in type of delivery, timing of delivery and outcomes of subsequent births. What does this paper add?Obstetric interventions and adverse maternal and infant outcomes were associated with changing maternity care provider and influenced whether or not women remained with the same care provider.

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Rates for obstetric intervention among private and public patients in Australia: population based descriptive study

Abstract: Objective To compare the risk profile of women receiving public and private obstetric care and to compare the rates of obstetric intervention among women at low risk in these groups.

Cited by 185 publications

References 22 publications

General obstetrics: Does size matter? A population‐based study of birth in lower volume maternity hospitals for low risk women

General obstetrics: Does size matter? A population‐based study of birth in lower volume maternity hospitals for low risk women

The impact of Childbirth experiences on women's sense of self: A review of the literature

Factors associated with changes into public or private maternity care for a second pregnancy

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