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

Miller, Yvette D., Prosser, Samantha J. and Thompson, Rachel (2012) Going public: Do risk and choice explain differences in caesarean birth rates between public and private places of birth in Australia?. Midwifery, 28 5: 627-635. doi:10.1016/j.midw.2012.06.003


Author Miller, Yvette D.
Prosser, Samantha J.
Thompson, Rachel
Title Going public: Do risk and choice explain differences in caesarean birth rates between public and private places of birth in Australia?
Journal name Midwifery   Check publisher's open access policy
ISSN 0266-6138
1532-3099
Publication date 2012-10
Sub-type Article (original research)
DOI 10.1016/j.midw.2012.06.003
Volume 28
Issue 5
Start page 627
End page 635
Total pages 9
Place of publication London, United Kingdom
Publisher Churchill Livingstone
Collection year 2013
Language eng
Formatted abstract
Background
women who birth in private facilities in Australia are more likely to have a caesarean birth than women who birth in public facilities and these differences remain after accounting for sector differences in the demographic and health risk profiles of women. However, the extent to which women's preferences and/or freedom to choose their mode of birth further account for differences in the likelihood of caesarean birth between the sectors remains untested.
Method
women who birthed in Queensland, Australia during a two-week period in 2009 were mailed a self-report survey approximately 3 months after birth. Seven hundred and fifty-seven women provided cross-sectional retrospective data on where they birthed (public or private facility), mode of birth (vaginal or caesarean) and risk factors, along with their preferences and freedom to choose their mode of birth. A hierarchical logistic regression was conducted to determine the extent to which maternal risk and freedom to choose one's mode of birth explain sector differences in the likelihood of having a caesarean birth.
Findings
while there was no sector difference in women's preference for mode of birth, women who birthed in private facilities had higher odds of feeling able to choose either a vaginal or caesarean birth, and feeling able to choose only a caesarean birth. Women had higher odds of having caesarean birth if they birthed in private facilities, even after accounting for significant risk factors such as age, body mass index, previous caesarean and use of assisted reproductive technology. However, there was no association between place of birth and odds of having a caesarean birth after also accounting for freedom to choose one's mode of birth.
Conclusions
these findings call into question suggestions that the higher caesarean birth rate in the private sector in Australia is attributable to increased levels of obstetric risk among women birthing in the private sector or maternal preferences alone. Instead, the determinants of sector differences in the likelihood of caesarean births are complex and are linked to differences in the perceived choices for mode of birth between women birthing in the private and public systems.
Keyword Childbirth
Intervention
Maternity experiences
Health insurance
Obstetric Intervention
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Psychology Publications
 
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