Plain language summary from BJOG's Stillbirth themed issue
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Babies born in Australian public hospitals tend to die more often than those born in private hospitals. Our aim was to determine whether this pattern is a result of public–private differences in care or merely linked with differences in the characteristics of the two groups. In Australian private hospitals, a private obstetrician almost always provides continuing care to each woman during pregnancy and birth. Public hospitals provide a number of care options, which usually involve midwives and/or a family doctor.
The study population included 131 436 births (52.5% public; 47.5% private) from 1998–2013 at a single metropolitan centre with co-located public and private facilities. To isolate the effect of differences in care, we used a statistical technique called propensity score matching to select a public group and a private group with similar characteristics and equal size. This enabled us to compare ‘apples with apples’ when comparing public versus private perinatal death rates. Perinatal deaths include stillbirths and babies that die within 28 days of birth.
After matching and after accounting for different patterns in the use of fertility treatments and multiple-birth pregnancies (such as twins), babies born in the public sector were approximately 1.5 times more likely to die than babies born in the private sector. This difference was reduced to 1.3 times more likely to die than babies born in the private sector after taking into account other factors that could skew the data, such as major congenital anomalies, birth method, and duration of pregnancy.
This was a single-centre study, so the results may not apply to all settings. Despite our efforts to create highly similar public and private cohorts, some differences between the groups are likely to have remained and this may have affected the results.
Our findings suggest that private obstetrician-led care has a beneficial impact on perinatal deaths, despite, or possibly because of, higher obstetric intervention rates and earlier births in the private hospital. Further research is required.
Reproduced from: Adams N, Tudehope D, Gibbons KS, Flenady V.Perinatal mortality disparities between public care and private obstetrician-led care: a propensity score analysis. BJOG 2018;125:149–158; https://doi.org/10.1111/1471-0528.14903