Birthing in regional Australia: women’s decision making surrounding birthplace
Alexa N. Seal
A F , Emma Hoban B C , Annette Panzera B D and Joe McGirr A E
A School of Medicine Sydney, Rural Clinical School Wagga Wagga, The University of Notre Dame Australia, PO Box 5050, Wagga Wagga, NSW 2650, Australia.
B Catholic Health Australia, PO Box 245, Civic Square, ACT 2608, Australia.
C Present address: Policy Analyst, Australian Healthcare and Hospital Association, PO Box 78, Deakin West, ACT 2600, Australia. Email: ehoban@ahha.asn.au
D Present address: Principal Advisor to the National Rural Health Commissioner, Australian Department of Health, GPO Box 9848, Canberra, ACT 2601, Australia. Email: annette.panzera@health.gov.au
E Present address: Member for Wagga Wagga, 64 Baylis Street, Wagga Wagga, NSW 2650, Australia. Email: Joe.McGirr@parliament.nsw.gov.au
F Corresponding author. Email: alexa.seal@nd.edu.au
Australian Health Review 45(5) 570-577 https://doi.org/10.1071/AH21067
Submitted: 4 March 2021 Accepted: 4 May 2021 Published: 10 August 2021
Abstract
Objective Although there is some research on women’s choice of birthplace, most of this research has been conducted overseas. This study explored factors influencing the decision to use public or private maternity services within regional Australia.
Methods This cross-sectional study consisted of a community-based, anonymous, online questionnaire focused on factors influencing a woman’s choice of birth location and included adult females who had given birth in the past 2 years within two regional areas. Descriptive statistics were used to analyse demographic characteristics and factors influencing decisions regarding birthplace. Pearson’s Chi-squared test was used to compare public and private births for multiple variables. Binary logistic regression was used to determine the odds ratio for each potential factor based on whether participants with private health insurance (PHI) elected to birth in the public or private regional hospitals. Open coding was used to group responses to open ended questions into themes.
Results Data from 510 questionnaires were analysed. The three most frequently reported factors influencing a woman’s decision about birthplace were financial reasons, the ability to choose their doctor and not having PHI. Women with PHI who opted for birth in the public system were almost four-fold more likely to select access to intensive care services and 2.6-fold more likely to select a preference for a low-intervention birth as one of their top five most influential factors. The results highlight that women want access to midwifery continuity of care.
Conclusion This study provides insights into the factors influencing a woman’s complex decision about where and with whom to birth and how health insurance affects that decision, an area where there is a paucity of peer-reviewed literature. This research highlights the importance of being able to choose one’s doctor and the desire for access to midwife-led models of care, and provides evidence to advocate for improved access to additional models of care in the private sector.
What is already known? The viability of regional private maternity hospitals is in question because, once the birth rate goes below a certain threshold, providing private obstetric service becomes unviable. Closure of regional private hospitals means less choice in regional areas. Minimal information is available about the factors influencing a woman with PHI to give birth in the public system, and much of the evidence is anecdotal.
What does this paper add? This study provides insight into how PHI status and other factors influence a woman’s decision to birth in the public versus private sector, an area where there is a paucity of peer-reviewed literature. It also highlights a desire from women for access to midwifery continuity of care in the private system.
What are the implications for practitioners? This research provides evidence to advocate for improved access to additional models of care, especially for midwifery-led care in the private sector.
Keywords: birthplace, continuity of care, maternity choices, model of care, private health insurance.
References
[1] Pavlova M, Hendrix M, Nouwens E, Nijhuis J, van Merode G. The choice of obstetric care by low-risk pregnant women in the Netherlands: Implication for policy and management. Health Policy 2009; 93 27–34.| The choice of obstetric care by low-risk pregnant women in the Netherlands: Implication for policy and management.Crossref | GoogleScholarGoogle Scholar | 19540012PubMed |
[2] Department of Health. The Australian health system, 2019. Available at: https://www.health.gov.au/about-us/the-australian-health-system [verified 14 December 2020].
[3] Australian Institute of Health and Welfare (AIHW). Private health insurance, Australia’s health 2020, 2020. Available at: https://www.aihw.gov.au/reports/australias-health/private-health-insurance [verified 23 July 2020].
[4] Stevens G, Thompson R, Kruske S, Watson B, Miller YD. What are pregnant women told about models of maternity care in Australia? A retrospective study of women’s reports. Patient Educ Couns 2014; 97 114–21.
| What are pregnant women told about models of maternity care in Australia? A retrospective study of women’s reports.Crossref | GoogleScholarGoogle Scholar | 25085552PubMed |
[5] Laws PJ, Sullivan EA. Australia’s mothers and babies 2003. AIHW Cat. No. PER 29. Sydney: AIHW National Perinatal Statistics Unit (Perinatal Statistics Series No. 16), 2005.
[6] Li Z, Zeki R, Hilder L, Sullivan EA. Australia’s mothers and babies 2011. Perinatal statistics series no. 28. Cat. no. PER 59. Canberra: AIHW National Perinatal Epidemiology and Statistics Unit, 2013.
[7] Australian Institute of Health and Welfare. Australia’s mothers and babies 2018: in brief, 2020. Perinatal statistics series no. 36. Cat. no. PER 108. Canberra: AIHW. Available at: https://www.aihw.gov.au/getmedia/aa54e74a-bda7-4497-93ce-e0010cb66231/aihw-per-108.pdf.aspx?inline=true [verified December 2020].
[8] HealthStats NSW. Place of birth by hospital peer group and year. Available at: http://www.healthstats.nsw.gov.au/Indicator/mab_placebth_cat/mab_placebth_cat_hos_peer [verified 12 March 2020].
[9] Australian Prudential Regulation Authority. 2020 Statistics: Private health insurance membership and coverage September 2020. Available at: https://www.apra.gov.au/quarterly-private-health-insurance-statistics [verified 15 December 2020].
[10] Productivity Commission. Private Hospitals in Australia, 1999. Commission Research Paper, AusInfo, Canberra.
[11] Office of the Health Ombudsman. Investigation report Safety and quality of maternity services across Central Queensland Hospital and Health Service, 2019. Available at: https://dxcgqpir544a8.cloudfront.net/reports/Gladstone-FINAL.pdf?mtime=20200429162809&focal=none [verified 27 April 2021].
[12] King D. Private Patients in Public Hospitals, 2003. Available at: http://www.achr.org.au/wp-content/uploads/2015/04/ACHR-Private-Patients-in-Public-Hospitals_2013.pdf [verified 12 March 2020]
[13] Borrelli SE, Walsh D, Spiby H. First-time mothers’ choice of birthplace: influencing factors, expectations of the midwife’s role and perceived safety. J Adv Nurs 2017; 73 1937–46.
| First-time mothers’ choice of birthplace: influencing factors, expectations of the midwife’s role and perceived safety.Crossref | GoogleScholarGoogle Scholar | 28181273PubMed |
[14] Houghton G, Bedwell C, Forsey M, Baker L, Lavender T. Factors influencing choice in birthplace–an exploration of the views of women, their partners and professionals. Evid Based Midwifery 2008. Available at: https://www.rcm.org.uk/learning-and-career/learning-and-research/ebm-articles/factors-influencing-choice-in-birth-place-%E2%80%93 [verified 17 March 2020]
[15] Adams J, Steel A, Frawley J, Broom A, Sibbritt D. Substantial out-of-pocket expenditure on maternity care practitioner consultations and treatments during pregnancy: estimates from a nationally-representative sample of pregnant women in Australia. BMC Pregnancy Childbirth 2017; 17 114
| Substantial out-of-pocket expenditure on maternity care practitioner consultations and treatments during pregnancy: estimates from a nationally-representative sample of pregnant women in Australia.Crossref | GoogleScholarGoogle Scholar | 28403816PubMed |
[16] Callander E, Fox H. Changes in out-of-pocket charges associated with obstetric care provided under Medicare in Australia. Aust N Z J Obstet Gynaecol 2018; 58 362–5.
| Changes in out-of-pocket charges associated with obstetric care provided under Medicare in Australia.Crossref | GoogleScholarGoogle Scholar | 29327343PubMed |
[17] Australian Institute of Health and Welfare. Australia’s mothers and babies data visualisations. Available at: https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies-data-visualisations/contents/baby-outcomes/hospital-length-of-stay-baby [verified 4 May 2021].
[18] McKellar L, Brown A, Adelson P. A public e-survey to explore community understanding of the role of the midwife in Australia. Eur J Midwifery 2019; 3 20
| A public e-survey to explore community understanding of the role of the midwife in Australia.Crossref | GoogleScholarGoogle Scholar | 33537599PubMed |
[19] Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for child-bearing women. Cochrane Database Syst Rev 2016; 4 CD004667
| Midwife-led continuity models versus other models of care for child-bearing women.Crossref | GoogleScholarGoogle Scholar | 27121907PubMed |
[20] Wilkes E, Gamble J, Adam G, Creedy DK. Reforming maternity services in Australia: Outcomes of a private practice midwifery service. Midwifery 2015; 31 935–40.
| Reforming maternity services in Australia: Outcomes of a private practice midwifery service.Crossref | GoogleScholarGoogle Scholar | 26092305PubMed |
[21] Homer CSE. Models of maternity care: evidence for midwifery continuity of care. Med J Aust 2016; 205 370–4.
| Models of maternity care: evidence for midwifery continuity of care.Crossref | GoogleScholarGoogle Scholar |
[22] Queensland Health. Maternity care options. Available at: https://www.health.qld.gov.au/cq/services/maternity/pregnancy/maternity-care-options [verified 20 July 2021].
[23] Mater Maternity. Food and Hospitality. Available at: http://www.matermaternity.com.au/services-and-facilities/food-and-hospitality/ [verified 17 March 2020].
[24] Better Health Victoria. Paying for pregnancy, birth and newborn baby care. Available at: https://www.betterhealth.vic.gov.au/health/servicesandsupport/paying-for-pregnancy-birth-and-newborn-care [verified 9 March 2020].
[25] Australian Medical Workforce Advisory Committee. The Specialist Obstetrics and Gynaecology Workforce – an update, 2003–2013, AMWAC Report 2004.2, Sydney, 2004, 18–20.
