Too posh to push? Ask my doctor

Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448. Link

Pregnant women in the private health system are not “too posh to push”, a new Queensland report has shown.

While significantly more mothers give birth by caesarean-section in private hospitals than in the public sector, it is not due to low pain thresholds.

Of course it's not due to lower pain thresholds: caesareans hurt too!

Research ... has revealed a dramatic difference in the way maternity care is provided in the two systems.

It found eight in 10 pregnant women in both sectors wanted a traditional delivery.

However figures provided by Queensland Health show almost half of all births in the state's private hospitals are by caesarean, compared to 27.6 per cent in the public sector.

About 62 per cent of women who had a caesarean in a private hospital said they had been recommended by their health care provider, compared to 40 per cent in the public sector.

In addition, 60 per cent of private caesareans were scheduled ahead of labour, compared to 41 per cent in public hospitals.

Research fellow Dr Yvette Miller said the findings disproved the popular belief that women who could afford the private system did not want a vaginal birth.

“A lot of differences [between public and private births] have previously been attributed to women’s choices,” Dr Miller said.

“What’s clear from our data is that doesn’t seem to be the case.

“Eighty per cent of women want a vaginal birth and there’s absolutely no difference between women in private and public hospitals."

Australian Medical Association Queensland president-elect Dr Richard Kidd said he believed the research showed private obstetricians were better at identifying when women required a caesarean.

How does he arrive at that conclusion? An ideal caesarean rate is 15%. The vast majority of caesareans are therefore unnecessary.

“Sixty per cent of the caesareans [in the public system] were not planned,"

And nor should they have been: a caesarean is a life-saving operation and as most "emergencies" occur in labour, this is the time that most caesareans will be performed.

... Dr. Miller said women needed to be better informed about the differences in maternity care in private and public hospitals.

Pregnancies and child birth in the private system were always looked after by an obstetrician, while in the public sector midwives handled care unless a risk was identified.

Dr Miller said obstetricians and midwives had vastly different approaches to maternity care. Obstetricians were more likely to use medical intervention, including caesareans, epidurals and induced labours.

“It’s not clear to most women when they become pregnant and start considering their options,” Dr Miller said.

“Private hospital care is not just better quality of the same care, it’s actually a different approach.”

Dr Miller said research now needed to focus on health care providers, including obstetricians, general practitioners and midwives, to understand why they took their different approaches.

... "They're all very, very committed to providing the best care for their patients, they just have different ideas about what that looks like.”

... "What we’re starting to see more and more is that the differences between the private and public system has to do with things like hospital policy [and] risk litigation strategies," she said.

... Queensland has the highest rate of caesarean-section births in Australia ...

Melissa Maimann, Essential Birth Consulting 0400 418 448