Rates of obstetric intervention among low-risk women giving birth in private and public hospitals in NSW: a population-based descriptive study

Abstract

ObjectivesTo compare the risk profile of women giving birth in private and public hospitals and the rate of obstetric intervention during birth compared with previous published rates from a decade ago.DesignPopulation-based descriptive study.SettingNew South Wales, Australia.Participants691 738 women giving birth to a singleton baby during the period 2000 to 2008.Main outcome measuresRisk profile of women giving birth in public and private hospitals, intervention rates and changes in these rates over the past decade.ResultsAmong low-risk women rates of obstetric intervention were highest in private hospitals and lowest in public hospitals. Low-risk primiparous women giving birth in a private hospital compared to a public hospital had higher rates of induction (31% vs 23%); instrumental birth (29% vs 18%); caesarean section (27% vs 18%), epidural (53% vs 32%) and episiotomy (28% vs 12%) and lower normal vaginal birth rates (44% vs 64%). Low-risk multiparous women had higher rates of instrumental birth (7% vs 3%), caesarean section (27% vs 16%), epidural (35% vs 12%) and episiotomy (8% vs 2%) and lower normal vaginal birth rates (66% vs 81%). As interventions were introduced during labour, the rate of interventions in birth increased. Over the past decade these interventions have increased by 5% for women in public hospitals and by over 10% for women in private hospitals. Among low-risk primiparous women giving birth in private hospitals 15 per 100 women had a vaginal birth with no obstetric intervention compared to 35 per 100 women giving birth in a public hospital.ConclusionsLow-risk primiparous women giving birth in private hospitals have more chance of a surgical birth than a normal vaginal birth and this phenomenon has increased markedly in the past decade.

Intervenções obstétricas durante o trabalho de parto e parto em mulheres brasileiras de risco habitual

“…Caesarean section rates were much lower in public hospitals, and among non-white women with lower levels of education, repeating a familiar pattern of inequality in Brazil 41,42 and in other countries 7,43 and showing that excessive rates of caesareans mainly affect Brazilian women with higher levels of education, affecting 89.9% of lowrisk women that use the private health system.…”

“…Women were defined as low-risk according to the following criteria used by Dahlen et al 7 : absence of pre-existing or pregnancy-related hypertension or diabetes; body mass index < 30 (above which the person is considered obese); HIV negative; gestational age between 37 and 41 weeks; singleton pregnancy with cephalic presentation; birth weight between 2,500 and 4,499g and between the 5th and 95th centiles of birth weight for gestational age.…”

Cesariana e resultados neonatais em hospitais privados no Brasil: estudo comparativo de dois diferentes modelos de atenção perinatal

“…The association between caesarean sections and private health care is well documented and occurs in developed and developing countries 2,3,4,5,6 . However, none of these countries has as high a caesarean section prevalence as that reported for the private sector in Brazil.…”

Obstetric and psychosocial risk factors for Australian-born and non-Australian born women and associated pregnancy and birth outcomes: a population based cohort study

“…Once again the high rate of GDM was seen amongst women born in China and a high caesarean section rate was seen for women born in India. Indian women also had a much higher rate of private health insurance and previous work we have undertaken has demonstrated this and the link between this and high obstetric intervention rates [16,17].…”