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New research shows increased obstetric intervention in private hospitals

By Karen Keast | Last Updated: 19-11-2013

Leader of the study Hannah Dahlen.

Low-risk women giving birth to their first baby in private hospitals are more likely to have a surgical birth than a normal vaginal birth, according to new Australian research.

A study of 691,738 women giving birth in New South Wales’ hospitals between 2000 and 2008 found the rates of obstetric intervention among low-risk women were highest in private hospitals and lowest in public hospitals.

The results of the study show private patients have higher rates of induction compared to public patients, at 31 per cent to 23 per cent; instrumental birth, at 29 per cent to 18 per cent; caesarean section, 27 per cent to 18 per cent, epidural, 53 per cent to 32 per cent, episiotomy, 28 per cent to 12 per cent, and lower normal vaginal birth rates, 44 per cent to 64 per cent.

The study also found 15 per 100 women in

private hospitals had a vaginal birth with no obstetric intervention compared to 35 per 100 women giving birth in public hospitals.

The University of Western Sydney study, published in the British Medical Journal’s Open journal, found the continual rise in obstetric intervention rates for low-risk women was “concerning” in terms of morbidity for women and also the cost to the public purse.

“The fact that these procedures which were initially life-saving are now so commonplace and do not appear to be associated with improved perinatal death rates demands close review,” it states.

“The findings of this study suggest that a two-tier system exists in Australia without any obvious benefit for women and babies and a level of medical over-servicing which is difficult to defend within a system that is bound by a finite health dollar.”

UWS Associate Professor of Midwifery and leader of the study Hannah Dahlen said the study excluded 70 per cent of the population to focus particularly on low-risk women who were aged between 20 and 34, who were not pre-term or post-term and carried babies of a normal weight.

“We are trying to myth bust some of these arguments that these women are older and the women are fatter and the women are sicker and the women are asking for it,” she said.

“We can’t do anything about the women who are asking for it, and the argument that women are of a larger body mass is correct, they are getting larger but women in the private sector are much more likely to be of a normal BMI.”

Dr Dahlen said women need to make an informed choice and the intervention rates of obstetricians should be made public through the government’s MyHospitals website.

“Then women can make a truly informed choice and they are starting to do this in the United States,” she said.

“Women need to know there are many more options out there if they really want a natural childbirth.”

Dr Dahlen said evidence showed continuity of midwifery care for low-risk women with healthy pregnancies produced outstanding outcomes for mothers and babies.

“We have got the best evidence in the world now to tell us that’s the gold standard,” she said.

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