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A retrospective cohort study of mode of delivery among public and private patients in an integrated maternity hospital setting.
Murphy, Deirdre J; Fahey, Tom
<p>The original is available at <a href="https://bmjopen.bmj.com/content/3/11/e003865">bmjopen.bmj.com</a></p> <p><strong>OBJECTIVE:</strong> To examine the associations between mode of delivery and public versus privately funded obstetric care within the same hospital setting.</p> <p><strong>DESIGN:</strong> Retrospective cohort study.</p> <p><strong>SETTING:</strong> Urban maternity hospital in Ireland.</p> <p><strong>POPULATION:</strong> A total of 30 053 women with singleton pregnancies who delivered between 2008 and 2011.</p> <p><strong>METHODS:</strong> The study population was divided into those who booked for obstetric care within the public (n=24 574) or private clinics (n=5479). Logistic regression analyses were performed to examine the associations between operative delivery and type of care, adjusting for potential confounding factors.</p> <p><strong>MAIN OUTCOME MEASURES:</strong> Caesarean section (scheduled or emergency), operative vaginal delivery (vacuum or forceps), indication for caesarean section as classified by the operator.</p> <p><strong>RESULTS:</strong> Compared with public patients, private patients were more likely to be delivered by caesarean section (34.4% vs 22.5%, OR 1.81; 95% CI 1.70 to 1.93) or operative vaginal delivery (20.1% vs 16.5%, OR 1.28; 95% CI 1.19 to 1.38). The greatest disparity was for scheduled caesarean sections; differences persisted for nulliparous and parous women after controlling for medical and social differences between the groups (nulliparous 11.9% vs 4.6%, adjusted (adj) OR 1.82; 95% CI 1.49 to 2.24 and parous 26% vs 12.2%, adj OR 2.08; 95% CI 1.86 to 2.32). Scheduled repeat caesarean section accounted for most of the disparity among parous patients. Maternal request per se was an uncommonly reported indication for caesarean section (35 in each group, p<0.000).</p> <p><strong>CONCLUSIONS:</strong> Privately funded obstetric care is associated with higher rates of operative deliveries that are not fully accounted for by medical or obstetric risk differences.</p>
Keyword(s): Caesarean Section; Cohort Study; Operative Delivery; Operative Vaginal Delivery; Private Healthcare.; Medicine and Health Sciences
Publication Date:
2013
Type: Journal article
Peer-Reviewed: Yes
Institution: Royal College of Surgeons in Ireland
Citation(s): Murphy DJ, Fahey T. A retrospective cohort study of mode of delivery among public and private patients in an integrated maternity hospital setting. BMJ Open. 2013;3(11):e003865.
Publisher(s): BMJ Publishing Group Ltd.
File Format(s): application/pdf
Related Link(s): https://epubs.rcsi.ie/gpart/135
First Indexed: 2019-05-10 07:15:57 Last Updated: 2019-05-10 07:15:57