Factors associated with changes into public or private maternity care for a second pregnancy
Jane B. Ford A C , Jason P. Bentley A B , Jonathan M. Morris A and Christine L. Roberts AA Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, Department of Obstetrics and Gynaecology, Level 2, Building 52, University of Sydney at Royal North Shore Hospital, Sydney, NSW 2006, Australia. Email: jonathan.morris@sydney.edu.au, clroberts@med.usyd.edu.au
B Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, NSW, Australia. Email: jbent@doh.health.nsw.gov.au
C Corresponding author. Email: jane.ford@sydney.edu.au
Australian Health Review 37(4) 495-500 https://doi.org/10.1071/AH12017
Submitted: 23 October 2012 Accepted: 3 July 2013 Published: 30 August 2013
Abstract
Objective The aim of this study was to determine whether outcomes in a first pregnancy were associated with changes into and out of public maternity care.
Methods The study population included 155 492 women with first and second sequential singleton births, 2000–09 in New South Wales. Analyses were stratified by whether obstetric care for the first birth involved private or public maternity care. Interventions, infant and maternal outcomes were assessed as predictors of a change in care. Adjusted odds ratios for changing care were obtained from logistic regression using backwards elimination.
Results Similar proportions of women changed from private to public care between first and second births (9.6% compared with 9.4% public to private, P-value = 0.10). Although interventions (operative delivery, epidural) and outcomes (low Apgar, preterm birth, perinatal death, postpartum haemorrhage, perineal tear and severe maternal morbidity) were all associated with changes from public to private care, only poor infant condition (adjusted odds ratio 1.39, 95% confidence interval 1.15–1.68) was associated with a change from private to public care.
Conclusions The majority of women had consistent care type for both births. This may indicate that women are generally satisfied with care, they rationalise that their first birth care was optimal or they value continuity of carer across pregnancies.
What is known about the topic? There is some evidence to suggest that interventions and outcomes of one pregnancy are associated with changes in type of delivery, timing of delivery and outcomes of subsequent births.
What does this paper add? Obstetric interventions and adverse maternal and infant outcomes were associated with changing maternity care sector and influenced whether or not women remained with the same care provider.
What are the implications for practitioners? Continuity of carer may be important to women in choosing their subsequent pregnancy maternity care sector. Most women do not change provider, but first-birth experiences appear to influence those who do change.
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