Private health care coverage and increased risk of obstetric intervention

Loading...
Thumbnail Image
Date
2014-01-13
Authors
Lutomski, Jennifer E.
Murphy, Michael
Devane, Declan
Meaney, Sarah
Greene, Richard A.
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Published Version
Research Projects
Organizational Units
Journal Issue
Abstract
Background: When clinically indicated, common obstetric interventions can greatly improve maternal and neonatal outcomes. However, variation in intervention rates suggests that obstetric practice may not be solely driven by case criteria. Methods: Differences in obstetric intervention rates by private and public status in Ireland were examined using nationally representative hospital discharge data. A retrospective cohort study was performed on childbirth hospitalisations occurring between 2005 and 2010. Multivariate logistic regression analysis with correction for the relative risk was conducted to determine the risk of obstetric intervention (caesarean delivery, operative vaginal delivery, induction of labour or episiotomy) by private or public status while adjusting for obstetric risk factors. Results: 403,642 childbirth hospitalisations were reviewed; approximately one-third of maternities (30.2%) were booked privately. After controlling for relevant obstetric risk factors, women with private coverage were more likely to have an elective caesarean delivery (RR: 1.48; 95% CI: 1.45-1.51), an emergency caesarean delivery (RR: 1.13; 95% CI: 1.12-1.16) and an operative vaginal delivery (RR: 1.25; 95% CI: 1.22-1.27). Compared to women with public coverage who had a vaginal delivery, women with private coverage were 40% more likely to have an episiotomy (RR: 1.40; 95% CI: 1.38-1.43). Conclusions: Irrespective of obstetric risk factors, women who opted for private maternity care were significantly more likely to have an obstetric intervention. To better understand both clinical and non-clinical dynamics, future studies of examining health care coverage status and obstetric intervention would ideally apply mixed-method techniques.
Description
Keywords
Caesarean section , Vacuum extraction , Obstetric forceps , Induction of labour , Episiotomy , Pregnancy
Citation
Lutomski JE, Murphy M, Devane D, Meaney S, Greene RA (2014) 'Private health care coverage and increased risk of obstetric intervention'. BMC Pregnancy and Childbirth'. BMC pregnancy and childbirth, 14 (13). http://dx.doi.org/10.1186/1471-2393-14-13