Beyond the hospital door: a retrospective, cohort study of associations between birthing in the public or private sector and women’s postpartum care

Abstract

BackgroundIn Australia, maternity care is available through universal coverage and a parallel, competitive private health insurance system. Differences between sectors in antenatal and intrapartum care and associated outcomes are well documented but few studies have investigated differences in postpartum care following hospital discharge and their impact on maternal satisfaction and confidence.MethodsWomen who birthed in Queensland, Australia from February to May 2010 were mailed a self-report survey 4 months postpartum. Regression analysis was used to determine associations between sector of birth and postpartum care, and whether postpartum care experiences explained sector differences in postpartum well-being (satisfaction, parenting confidence and feeling depressed).ResultsWomen who birthed in the public sector had higher odds of health professional contact in the first 10 days post-discharge and satisfaction with the amount of postpartum care. After adjusting for demographic and postpartum contact variables, sector of birth no longer had an impact on satisfaction (AOR 0.95, 99% CI 0.78-1.31), but any form of health professional contact did. Women who had a care provider’s 24 hour contact details had higher odds of being satisfied (AOR 3.64, 95% CI 3.00-4.42) and confident (AOR 1.34, 95% CI 1.08- 1.65).ConclusionWomen who birthed in the public sector appeared more satisfied because they had higher odds of receiving contact from a health professional within 10 days post-discharge. All women should have an opportunity to speak to and/or see a doctor, midwife or nurse in the first 10 days at home, and the details of a person they can contact 24 hours a day.

Influence of dietary intake and decision‐making during pregnancy on birth outcomes

“…This recruitment environment resulted in an inability to compare the intake and outcomes of women engaging private maternity services. While women with high income and education levels are more likely to access private models of care, potential inequities have been negated by the heterogeneity of income brackets and the high percentage of university‐educated women in the cohort. Furthermore, data were collected from a representative cohort of the South‐East Queensland region, and included data declared by women of cultural, linguistic, literacy and socio‐economic diversity.…”

Maternal Health Care Expenditure among Women in Rural Areas of Pakistan

“…14 In our study significant difference was seenbetween expense in public vs private sector, SVD vs C-section, which shows health care is expensive in private sector as compared to private sector.In contrast to other countries where public sector is considered more reliable, 15 in Pakistan the use of private health facility increases with increasing maternal education and socio-economic status of the family. 16 With minimum suggested rate of < 5% for C-section by WHO, 17 the rates are rising alarmingly worldwide with its determinants being controversial in lower-middle income countries.…”

Postnatal ER visits within 30 days—Pattern, risk factors and implications for care

“…This is aligned with Goulet, D'Amour, and Pineault () findings; namely, timing of postnatal follow‐up is essential after discharge. Brodribb, Zadoroznyj, Nesic, Kruske, and Miller () suggested that, to improve maternal satisfaction with postdischarge postpartum care, women should routinely have contact with a healthcare professional within 10 days of discharge – regardless of hospital stay length. Danbjorg, Wagner, and Clemensen () suggested that midwifery follow‐up support in many western countries should be expanded and more qualified following childbirth.…”