Private health care coverage and increased risk of obstetric intervention

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dc.contributor.author Lutomski, Jennifer E.
dc.contributor.author Murphy, Michael
dc.contributor.author Devane, Declan
dc.contributor.author Meaney, Sarah
dc.contributor.author Greene, Richard A.
dc.date.accessioned 2014-10-01T12:36:50Z
dc.date.available 2014-10-01T12:36:50Z
dc.date.issued 2014-01-13
dc.identifier.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 en
dc.identifier.volume 14 en
dc.identifier.startpage 13 en
dc.identifier.issn 1471-2393
dc.identifier.uri http://hdl.handle.net/10468/1678
dc.identifier.doi 10.1186/1471-2393-14-13
dc.description.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. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher BioMed Central en
dc.relation.uri http://www.biomedcentral.com/1471-2393/14/13
dc.rights © 2014 Lutomski et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. en
dc.rights.uri http://creativecommons.org/licenses/by/2.0 en
dc.subject Caesarean section en
dc.subject Vacuum extraction en
dc.subject Obstetric forceps en
dc.subject Induction of labour en
dc.subject Episiotomy en
dc.subject Pregnancy en
dc.title Private health care coverage and increased risk of obstetric intervention en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Richard Greene, Obstetrics & Gynaecology, University College Cork, Cork, Ireland. +353-21-490-3000 Email: r.greene@ucc.ie en
dc.internal.availability Full text available en
dc.date.updated 2014-08-28T15:05:07Z
dc.description.version Published Version en
dc.internal.rssid 255442110
dc.description.status Peer reviewed en
dc.identifier.journaltitle BMC Pregnancy and Childbirth en
dc.internal.copyrightchecked Yes. CORA!! PV permitted en
dc.internal.licenseacceptance Yes en
dc.internal.IRISemailaddress r.greene@ucc.ie en


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© 2014 Lutomski et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Except where otherwise noted, this item's license is described as © 2014 Lutomski et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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