Going public: Do risk and choice explain differences in caesarean birth rates between public and private places of birth in Australia?

Back to normal: A retrospective, cross-sectional study of the multi-factorial determinants of normal birth in Queensland, Australia

“…Previous research has demonstrated higher rates of intervention in private facilities for procedures including induction of labour, epidural anaesthesia, episiotomy, instrumental vaginal birth, and caesarean section (Robson et al, 2009;Miller et al, 2012;Dahlen et al, 2012;Einarsdóttir et al, 2013;Dahlen et al, 2014). Higher rates of intervention are unlikely to be attributable to case mix differences as women in private facilities Islander identification, area of residence, continuity of carer during pregnancy, having a care providers contact details during pregnancy, assisted reproductive technology, gestational diabetes, pre-eclampsia or hypertension, placenta praevia, other pregnancy risk factors, continuity of carer for labour and birth, having a known care provider for labour and birth, water immersion during labour, planned place of birth, type of birth facility, and timing of birth.…”

“…typically have fewer pre-existing health conditions and obstetric complications during pregnancy than women in public facilities (Roberts et al, 2000;Robson et al, 2009;Miller et al, 2012) and differences have been shown to persist when limiting the comparison groups to low-risk women (Dahlen et al, 2012;Einarsdóttir et al, 2013;Dahlen et al, 2014). There remains an imperative to better understand the drivers for increased use of medical intervention in private sector maternity care.…”

“…Compared with the total population of birthing women in Queensland in 2009, the sample was largely representative for mode of birth, previous caesarean childbirth, gestational age at birth, and area of residence (Miller et al, 2012). The sample under-represented women who were younger than 20 years of age, birthed in a public facility, were multiparous, or identified as Aboriginal and/or Torres Strait Islander, and over-represented women who has used assisted reproductive technology to become pregnant (Miller et al, 2012).…”

“…Literature from Australia and several other countries indicates that the majority of women report the desire for minimal medical intervention during birth (Gamble and Creedy, 2001;Thomas et al, 2001;Kringeland et al, 2010;Miller et al, 2012). A systematic review and meta-analysis of 23 studies in various countries published since 2000 found that only a minority of women (13.8% overall) expressed a preference for caesarean birth over vaginal birth (Mazzoni et al, 2011).…”

Keeping it Natural: Does Persuasive Magazine Content Have an Effect on Young Women’s Intentions for Birth?

“…Evidence suggests that while women's preferences are important and have been shown to have an impact on their birth outcomes, other factors, such as sector of birth facility (i.e., public or private health system) and hospital policies (e.g., options provided for women with previous caesarean section), affect rates of medical procedure use (Hildingsson, Rådestad, and Lindgren 2010;Miller, Prosser, and Thompson 2012). Reducing the rate of medically unnecessary intervention in birth may require all stakeholders to consider how they contribute to this concern.…”