Caesareans higher among private patients

Caesareans higher among private patients

Pregnant women with private health care are twice as likely to have a scheduled caesarean birth, according to a new study. A study of more than 30,000 women who gave birth at an Irish hospital found that private patients were more likely to have a C-section or a surgical delivery with vacuum or forceps than those whose treatment was publicly funded.

Although women with private health care are generally older, and therefore at higher risk of complications in childbirth, the disparity between the two groups was not fully explained by differences in their medical condition, researchers said.

It was not clear whether the higher rate of operative deliveries was driven by patients or doctors but it "seems quite likely that private patients are provided with greater choice", they added.


The researchers, from Trinity College Dublin, studied data on 5,479 private patients and 24,574 publicly funded patients at the same Irish hospital to determine whether private care results in greater use of expensive procedures by doctors.

Private patients were on average older, wealthier and better educated than publicly funded patients, and were less likely to be single, childless, to have had an unplanned pregnancy or to have booked late for obstetric care.

Although they were less likely to have a medical disorder, private patients were also more likely to have had fertility treatment, problems with miscarriages, or had a previous stillbirth or child who died in infancy.

Results published in the BMJ Open journal showed that 21 per cent of private patients had a scheduled caesarean compared with nine per cent of public patients.

The difference was particularly great among women who had given birth before by C-section, while private patients were also more likely to have a surgical vaginal delivery using a vacuum or forceps.

One common argument for planned C-section is that the procedure does less damage to the pelvic floor than a natural birth, but the study showed that very few requests of this type were made.

Researchers said that older age and higher income among private patients could have played a part, while older and better educated women may also be more influenced by the fact that many obstetricians choose scheduled caesarean section for themselves.

They said the study "highlighted important differences in operative delivery rates that raise questions about equity." American studies have suggested that private health care can result in patients being overtreated because of financial incentives which reward inefficiency.

Private accommodation charges are estimated to generate up to 20 per cent of the hospital budget in Dublin Maternity Hospitals, and changes to UK health policy mean English hospitals will now be allowed to generate up to 49 per cent of their income from private hospitals.

The researchers wrote: "One would expect that every woman, irrespective of the funding source, is managed in a way that results in the best possible outcomes for mother and baby.

"Although speculative, it seems quite likely that private patients are provided with greater choice in relation to a scheduled caesarean section. It is debatable whether this is actually in the woman’s best interest, particularly when it comes to the next birth.

"What does need to be addressed is whether higher rates of scheduled caesarean sections among private patients create access issues for medically indicated caesarean sections, and whether these patients place a disproportionate burden on the service in the postoperative period."

By Nick Collins

The Telegraph, 26th November 2013

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