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Maternal and Neonatal Outcomes and Health System Costs in Standard Public Maternity Care Compared to Private
Emily J Callander1,2, Joanne Enticott1, Ben W Mol3
1Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia.
Objective:
We aimed to compare health outcomes and costs in standard public maternity care compared to private obstetric-led maternity care.
Design:
Observational study with linked administrative data.
Setting:
Australian maternity care.
Population:
867 334 births, covering all births in three states of Australia between 2016 and 2019.
Methods:
Standard public care involved mainly fragmented midwifery, obstetric and General Practitioner provider care, with birth in a public hospital. Private obstetric-led care was led by a personally selected obstetrician, with midwifery involvement and birth in a private hospital. We analysed outcomes from pregnancy onset to 4 weeks post-birth. Matching was utilised to account for demographic, socio-economic and clinical characteristics.
Main Outcome Measures:
Stillbirths or neonatal deaths; neonatal intensive care admissions; APGAR score < 7 at 5 min; 3rd or 4th degree perineal tears; maternal haemorrhages; mean cost per pregnancy episode.
Results:
Higher adverse outcomes in standard public maternity care compared to private obstetric-led care, including 778 more stillbirths or neonatal deaths (OR 2.0, 95% CI: 1.8-2.1), 2747 more APGAR score < 7 at 5 min (OR 2.0, 95% CI: 2.0-2.1), 3273 more 3rd or 4th degree perineal tears (OR 2.9, 95% CI: 2.7-3.1) and 10 627 additional maternal haemorrhages (OR 2.7, 95% CI: 2.6-2.8). Mode of birth correlated with neonatal death. Mean cost to all funders in Australian dollars per pregnancy episode was $5929 higher in standard public maternity care.
Conclusion:
We have shown significantly lower adverse health outcomes and costs in private obstetric-led care compared to standard public maternity care.
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