For women delivering a single baby at term in Australia, the prevalence of adverse perinatal outcomes is higher in public hospitals than in private hospitals.
These are the findings of a study published online by the Medical Journal of Australia – Adverse outcomes of labour in public and private hospitals in Australia: a population-based descriptive study.
Almost all women in Australia have free access to public hospitals, where intrapartum pregnancy care is usually provided by a mixture of midwives, junior medical officers, specialty trainees, and specialist obstetricians. In contrast, women choosing to deliver in private hospitals have their care directly managed by specialist obstetricians.
Compared with public hospitals, birth in Australian private hospitals is characterised by a higher rate of obstetric interventions such as induction of labour, episiotomy, instrumental delivery, and caesarean section and this has attracted criticism as being unnecessary.
In view of the government financial support available to women who take out private health insurance, it would be an obvious concern if the private hospital, obstetrician-led model of care, with its increased rates of medical intervention, did not provide measurable benefits for women and their babies when compared with the public hospital mixture of “all” models of care.
Using national data for 789 240 full-term births over a recent 4-year period, almost a third of which took place in private hospitals, Associate Professor Stephen Robson, of the Australian National University Medical School, and his colleagues, Elizabeth Sullivan and Paula Laws from the Perinatal and Reproductive Epidemiology Research Unit, University of New South Wales, found that women giving birth in public hospitals had more than twice the rate of severe perineal tearing, and their babies were also more than twice as likely to require high-level resuscitation at birth. Low Apgar scores (indicating possible health problems) and intensive care admission were also more common in babies born in public hospitals.
Neonatal death rates were 1 in 1000 in private hospitals and 3 in 1000 in public hospitals.
“We hope that the results of this population-based study will stimulate further research into the effect of different models of intrapartum care on pregnancy outcome” said Dr Robson, commenting on the study’s findings.
Source: Medical Journal of Australia, Australia