Rates for obstetric intervention among private and public patients in Australia: population based descriptive study

Objective To compare the risk profile of women receiving public and private obstetric care and to compare the rates of obstetric intervention among wo men at low risk in these groups. Design Population based descriptive study. Setting New South Wales, Australia. Subjects All 171 157 women having a live baby during 1996 and 1997. Interventions Epidural, augmentation or induction of labour episiotomy, and births by forceps, vacuum, or caesarean section. Main outcome measures Ris k profile: of public and private patients, intervention rates, and the accu mulation of interventions by both patient and hospital classification (publ ic or private). Results Overall, the frequency of women classified as low risk was similar (48%) among those choosing private obstetric care and those receiving stand ard care in a public hospital. Among low risk women, rates of obstetric int ervention were highest in private patients in private hospitals, lowest in public patients, and generally intermediate for private patients in public hospitals. Among primiparas at low risk, 34% of private patients in private hospitals had a forceps or vacuum delivery compared with 17% of public pat ients. For multiparas the rates were 8% and 3% respectively. Private patien ts were significantly more likely to have interventions before birth (epidu ral, induction or augmentation) but this alone did not account for the incr eased interventions at birth, particularly the high rates of instrumental b irths. Conclusions Public patients have a lower chance of an instrumental delivery . Women should have equal access to quality maternity services, but informa tion on the outcomes associated with the various models of care may influen ce their choices.