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
- 1Family and Community Health Research Group, School of Nursing and Midwifery, University of Western Sydney, Penrith, New South Wales, Australia
- 2Royal Hospital for Women, University of Sydney, Sydney, Australia
- 3Centre for Newborn Care, Westmead Hospital, Westmead, New South Wales, Australia
- 4School of Medicine, University of Sydney, Camperdown, New South Wales, Australia
- 5Royal Hospital for Women, Randwick, New South Wales, Australia
- 6School of Women and Children's Health, University of NSW, Randwick, New South Wales, Australia
- 7NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
- Correspondence to Professor Hannah G Dahlen;
- Received 25 November 2013
- Revised 29 April 2014
- Accepted 30 April 2014
- Published 21 May 2014
Objectives To 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).
Design Linked data population-based retrospective cohort study involving five data sets.
Setting New South Wales, Australia.
Participants 691 738 women giving birth to a singleton baby during the period 2000–2008.
Main outcome measures Rates 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.
Results Rates 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.
Conclusions For 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.
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