Research reveals differences in childbirth outcomes between public and private hospitals
New research indicates that women giving birth in public hospitals experience a higher proportion of spontaneous vaginal births compared to those in private hospitals, where caesarean sections are more prevalent.
Published in BMJ Open today, the paper, led by Western Sydney University in collaboration with University Medical Center Groningen, Amsterdam University Medical Center, and University of Central Lancaster, provides critical insights into how the mode of a woman's first birth affects subsequent births.
The research analysed data from over 172,000 low-risk women in New South Wales, over a 15-year period from 2001-2016, focusing on healthy first-time mothers and their second and third births. The descriptive study uses a women's life course approach to understand birth patterns but does not account for individual clinical reasons influencing birth mode choices.
Among women with two births, 55.8 per cent in public hospitals had vaginal births, compared to 36.8 per cent in private hospitals.
For women with three births, 57.2 per cent in public hospitals experienced a vaginal-vaginal-vaginal sequence, compared to 38.8 per cent in private hospitals.
Co-author of the study Professor Hannah Dahlen, from the University's School of Nursing and Midwifery and Translational Health Research Institute, states that the research highlights significant differences between public and private hospital models, as interventions in childbirth have increased in recent decades.
"Our findings reveal the importance of maximising women's chances of a vaginal birth for the first birth as it impacts what happens in future births," said Professor Dahlen.
Professor Dahlen continued, "Women with an operative birth, including vaginal births using instruments or caesarean sections, are less likely to have vaginal births subsequently."
The study reveals that women who had an initial spontaneous vaginal birth have a 91.3 per cent likelihood of having subsequent vaginal births, regardless of the hospital type. In contrast, women who had an initial elective caesarean section had an 81.9 per cent probability of subsequent elective caesarean births.
When comparing probabilities between public and private hospital models, the likelihood of subsequent elective caesarean births is higher in private hospitals at 84.9 per cent compared to 76.9 per cent in public hospitals.
For women with an initial emergency caesarean section, the probability of a subsequent emergency caesarean was 17.9 per cent, while the probability of a subsequent elective caesarean section stood at 67.4 per cent.
Lead author and Clinical Epidemiologist Dr Lilian Peters from University Medical Center Groningen and Adjunct Fellow at Western Sydney University, noted that significant differences were observed based on the maternity care funding model.
"Women identified as low-risk and receiving care from private obstetricians were more likely to experience interventions during childbirth compared to women in the public health system," Dr Peters commented.
"The findings may shape future maternal health studies and models, providing important data for healthcare professionals, policymakers, and expectant mothers. This highlights the need to support informed birth choices and consider the implications of maternity care models on long-term outcomes for mothers and families."
To read the full paper, 'How does the first index mode of birth in public or private hospitals predict subsequent births? A 16-year Australian population-based linked data study', download here.
