Challenging the assumption that higher rates of intervention provide no benefits for babies
Hardly a week seems to pass in Australia without an article in national newspapers drawing attention to the differences in obstetric intervention rates between private patients cared for by obstetricians and public patients who receive various models of care.1 The reported assumption has consistently been that the higher intervention rates observed in private patients are of no benefit to women or their babies, and possibly cause harm. This opinion has inevitably led to suggestions that federal support for private obstetric care be scaled back and redirected to models of care with lower intervention rates.2
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- 1. Robotham J. Public hospitals versus private: the painful truth about childbirth. Sydney Morning Herald 2009; 3 Jan. http://www.smh.com.au/news/national/public-hospitals-versus-private-the-painful-truth-about-childbirth/2009/01/02/1230681748836.html (accessed Mar 2009).
- 2. Barclay L, Tracy S, Kildea S. Maternity health reform has harmed women (but not obstetricians). Crikey 2008; 19 Nov. http://www.crikey.com.au/Politics/20081119-How-health-reform-has-harmed-women-but-been-very-good-for-the-obstetrics-business.html (accessed Mar 2009).
- 3. Robson SJ, Laws P, Sullivan EA. Adverse outcomes of labour in public and private hospitals in Australia: a population-based descriptive study. Med J Aust 2009; 190: 474-477. <MJA full text>
- 4. Bryant R. Improving maternity services in Australia: the report of the Maternity Services Review. Canberra: Commonwealth of Australia, Feb 2009. http://www.health.gov.au/internet/main/publishing.nsf/Content/maternityservicesreview-report (accessed Mar 2009).
- 5. Roberts CL, Tracy S, Peat B. Rates for obstetric intervention among private and public patients in Australia: population based descriptive study. BMJ 2000; 321: 137-141.
- 6. Vashevnik S, Walker S, Permezel M. Stillbirths and neonatal deaths in appropriate, small and large birthweight for gestational age fetuses. Aust N Z J Obstet Gyncaecol 2007; 47: 302-306.
- 7. Hall L. Baby toll lower in private hospitals. The Australian 2009; 16 Feb. http://www.theaustralian.news.com.au/story/0,25197,25059394-23289,00.html (accessed Mar 2009).
- 8. MacDorman MF, Declercq E, Menacker F, Malloy MH. Neonatal mortality for primary cesarean and vaginal births to low-risk women: application of an ‘‘intention-to-treat’’ model. Birth 2008; 35: 3-8.
I am currently Chairman of the National Association of Specialist Obstetricians and Gynaecologists.