Private hospitals drive surge in caesareans, inductions

A new study led by the University of Western Sydney has found low risk women giving birth in private hospitals in New South Wales are much more likely to have obstetric interventions such as inductions and caesareans compared to low risk women giving birth in public hospitals.

The study, published online today in the British Medical Journal Open,(opens in a new window) found women having their first baby in a private hospital had a 20 percent lower normal vaginal birth rate, and 15 percent lower rate if it was a subsequent baby.

Associate Professor Hannah Dahlen, from the UWS School of Nursing and Midwifery, studied over 650,000 births in New South Wales over eight years (2000-2008).

The study allowed researchers to determine if taking a matched low risk population would result in different levels of obstetric intervention for women giving birth in private and public hospitals.

It also repeated a study undertaken a decade ago, providing a clear indication of current trends in childbirth.

Associate Professor Dahlen's findings show low-risk women giving birth to their first baby in a private hospital compared to a public hospital had:

  • Higher rates of induction (31 percent vs 23 percent)
  • Higher rates of instrumental birth (29 percent vs 18 percent)
  • Higher rates of caesarean section (27 precent vs 18 percent)
  • Higher rates of epidural (53 percent vs 32 precent)
  • Higher rates of episiotomy (28 percent vs 12 percent)
  • Lower rates of vaginal births (44 percent vs 64 percent)

"The results stunned us," says Professor Dahlen. "Ten yeas ago we were concerned at what came out, but today there is no conceivable explanation for such high rates of intervention in the private sector. When only 15 out of 100 low risk, healthy young women have a normal vaginal birth without intervention for their first baby in a private hospital, then questions need to be asked."

Over the past decade the rate of caesarean amongst low risk women has risen by 5 percent in the public sector and double that in the private sector (10 precent).

"If we were saving more babies then we would accept this as necessary for safety, but we are not," says Associate Professor Dahlen.

"The argument that is often used by private obstetricians is women are older and sicker now and therefore the rates of intervention are higher, but we have controlled for that and included the same low risk criteria used a decade ago (20-34 years of age, no medical or obstetric complications, term babies and babies with good birth weights), and the intervention rate is only going one way, and that is up and up.

"The cost to the public purse of such high levels of intervention is not insignificant, not to mention the impact on women's health and the short and long-term health of children. With emerging evidence of links between caesarean section and diabetes, asthma, obesity and other immunological disorders in children, it is time to take a serious look at this issue," says Professor Dahlen.

The paper, titled: Rates of intervention among low risk women giving birth in private and public hospitals in NSW: A population-based descriptive study, can be obtained free online from the BMJ Open.


7 September 2012

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Contact: Mark Smith, Media Officer