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

Abstract

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.

Perinatal mortality disparities between public care and private obstetrician‐led care: a propensity score analysis

“…As in our study, Robson et al in Australia (2009, n = 789 240) and Coory et al in Queensland (2009, n = 124 300) reported higher rates of perinatal mortality among public compared with private births at term, despite adjusting for eight and 23 potential confounding factors, respectively (Robson et al, aOR 2.02, 95% CI 1.78–2.29; Coory et al, aOR 2.1, 95% CI 1.5–2.9). Dahlen et al (2014) compared perinatal mortality of term babies born to 237 304 low‐risk women, and found no significant intersector difference after adjusting for maternal and gestational ages (aOR 1.49, 95% CI 0.93–2.41).…”

“…We adjusted for major congenital anomalies as part of the treatment effect because the incidence of these may be influenced by the model of care . Adjustments were made for birth method and gestational age because prior research has identified intersector differences in clinical practices with respect to these factors …”

“…Studies in Australia, and elsewhere, have reported mixed results when comparing perinatal mortality for public and private births. These varied results reflect the difficulty in adjusting for potentially confounding differences between dissimilar cohorts.…”

“…15 Women can access private care at either a public or private hospital by purchasing private health insurance or by self-funding. 15 Studies in Australia, 6,14,16 and elsewhere, [17][18][19][20] have reported mixed results when comparing perinatal mortality for public and private births. These varied results reflect the difficulty in adjusting for potentially confounding differences between dissimilar cohorts.…”

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].…”