Obstetric Interventions for Low‐Risk Pregnant Women in France: Do Maternity Unit Characteristics Make a Difference?

Abstract

Background In many countries the closure of small maternity units has raised concerns about how the concentration of low‐risk pregnancies in large specialized units might affect the management of childbirth. We aimed to assess the role of maternity unit characteristics on obstetric intervention rates among low‐risk women in France. Methods Data on low‐risk deliveries came from the 2010 French National Perinatal Survey of a representative sample of births (n = 9,530). The maternity unit characteristics studied were size, level of care, and private or public status; the interventions included induction of labor; cesarean section; operative vaginal delivery (forceps, spatulas or vacuum); and episiotomy. Multilevel logistic regression analyses were adjusted for maternal confounding factors, gestational age, and infant birthweight. Results The rates of induction, cesarean section, operative delivery, and episiotomy in this low‐risk population were 23.9 percent, 10.1 percent, 15.2 percent, and 19.6 percent, respectively, and 52.0 percent of deliveries included at least one of them. Unit size was unrelated to any intervention except operative delivery (adjusted odds ratio [aOR] = 1.47 (95% CI, 1.10–1.96) for units with >3,000 deliveries per year vs units with <1,000). The rate of every intervention was higher in private units, and the aOR for any intervention was 1.82 (95% CI, 1.59–2.08). After adjustment for maternal characteristics and facility size and status, significant variations in the use of interventions remained between units, especially for episiotomies. Results for level of care were similar to those for unit size. Conclusions The concentration of births in large maternity units in France is not associated with higher rates of interventions for low‐risk births. The situation in private units could be explained by differences in the organization of care. Additional research should explore the differences in practices between maternity units with similar characteristics. (BIRTH 39:3 September 2012)

Service configuration, unit characteristics and variation in intervention rates in a national sample of obstetric units in England: an exploratory analysis

“…Our findings confirm that variations in intervention rates are not fully explained by the sociodemographic or clinical characteristics of women planning to give birth 10–12. While we did observe significant associations between OU size and midwifery staffing and some intervention rates, our results do not suggest that there is a straightforward or clear relationship between these factors13 14 and intervention rates, at least within the ranges observed within our sample. Our further exploratory analyses showed strong positive associations between intervention rates in ‘low-risk’ and ‘higher risk’ women planning birth in the same OU, which suggests that intervention rates may be affected by some institutional level factor, an ‘interventionist culture’, for example, or simply that the same influences on intervention rates apply to all births in any given setting.…”

“…Previous studies have found some association between junior doctor staffing levels and intervention rates,13 and mixed or inconclusive results on the relationship between unit size or the level of neonatal care available and intervention rates 14–16. Studies in France and Australia suggest that smaller units may have lower rates of some interventions, but in these studies, smaller units differed from larger units in other ways including, for example, the level of obstetric and neonatal care available and rurality 14 26. Our findings confirm that variations in intervention rates are not fully explained by the sociodemographic or clinical characteristics of women planning to give birth 10–12.…”

Cesariana e resultados neonatais em hospitais privados no Brasil: estudo comparativo de dois diferentes modelos de atenção perinatal

“…The association between caesarean sections and private health care is well documented and occurs in developed and developing countries 2,3,4,5,6 . However, none of these countries has as high a caesarean section prevalence as that reported for the private sector in Brazil.…”

Ampliando o debate

“…It should be noted that the higher use of obstetric interventions and c-sections in women served by the private sections has been observed in a number of countries around the world, not only in Brazil 22,23,24 .…”