Private health care coverage and increased risk of obstetric intervention

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dc.contributor.authorLutomski, Jennifer E.
dc.contributor.authorMurphy, Michael
dc.contributor.authorDevane, Declan
dc.contributor.authorMeaney, Sarah
dc.contributor.authorGreene, Richard A.
dc.date.accessioned2014-10-01T12:36:50Z
dc.date.available2014-10-01T12:36:50Z
dc.date.issued2014-01-13
dc.date.updated2014-08-28T15:05:07Z
dc.description.abstractBackground: 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.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationLutomski 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/10.1186/1471-2393-14-13en
dc.identifier.doi10.1186/1471-2393-14-13
dc.identifier.issn1471-2393
dc.identifier.journaltitleBMC Pregnancy and Childbirthen
dc.identifier.startpage13en
dc.identifier.urihttps://hdl.handle.net/10468/1678
dc.identifier.volume14en
dc.language.isoenen
dc.publisherBioMed Centralen
dc.relation.urihttp://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.urihttp://creativecommons.org/licenses/by/2.0en
dc.subjectCaesarean sectionen
dc.subjectVacuum extractionen
dc.subjectObstetric forcepsen
dc.subjectInduction of labouren
dc.subjectEpisiotomyen
dc.subjectPregnancyen
dc.titlePrivate health care coverage and increased risk of obstetric interventionen
dc.typeArticle (peer-reviewed)en
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