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

Hannah G. Dahlen, Sally Tracy, Mark Tracy, Andrew Bisits, Chris Brown, Charlene Thornton

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36 Citations (Scopus)

Abstract

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.

Original languageEnglish
Article numbere004551
Number of pages10
JournalBMJ Open
Volume4
Issue number5
DOIs
Publication statusPublished - Apr 2014
Externally publishedYes

Bibliographical note

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 3.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/3.0/

Keywords

  • Perinatal mortality
  • perinatal morbidity
  • low-risk women
  • private hospital birth
  • public hospital birth
  • Linked health data
  • population-based study

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