Adverse Outcomes of Labour in Public and Private Hospitals in Australia: A Population-based Descriptive Study

This research study has been published in The Medical Journal of Australia. It seems to prove that private hospital obstetric care is best for women. However, on closer examination, you will see that women who had private health insurance, but birthed in a public hospital, were excluded from the study. Hence, only the healthiest women in private hospitals were included. Public hospital data for this study, however, included women and babies of all level of risk. If one arm of the study includes women of all levels of risk, whereas the other arm only includes women of low risk, it is no wonder the latter study arm appears to be the best one. The study excluded babies born outside of 37-41 weeks.

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Stephen J Robson, Paula Laws and Elizabeth A Sullivan


Objective: To compare the rate of serious adverse perinatal outcomes of term labour between private and public maternity hospitals in Australia.

Main outcome measures: Third- and fourth-degree perineal injury, requirement for high level of neonatal resuscitation, Apgar score < 7 at 5 minutes, admission to neonatal intensive care unit or special care nursery, and perinatal death.

Results: 31.4% of the term singleton births occurred in private hospitals. After adjusting for maternal age, Indigenous status, parity, smoking status, diabetes, hypertension, remoteness of usual residence, and method of birth, the rates of all adverse outcomes studied were higher for public hospital births. For women, the adjusted odds ratio (AOR) for third- or fourth-degree perineal injury was 2.28 (95% CI, 2.16–2.40). For babies, the odds of a high level of resuscitation (AOR, 2.37; 95% CI, 2.17–2.59), low Apgar score (AOR, 1.75; 95% CI, 1.65–1.84), intensive care requirement (AOR, 1.48; 95% CI, 1.45–1.51) and perinatal death (AOR, 2.02; 95% CI, 1.78–2.29) were all higher in public hospitals.

Conclusion: For women delivering a single baby at term in Australia, the prevalence of adverse perinatal outcomes is higher in public hospitals than in private hospitals.

Melissa Maimann, Essential Birth Consulting.