Adverse outcomes of labour in public and private hospitals in Australia: a population-based descriptive study.
OBJECTIVE
To compare the rate of serious adverse perinatal outcomes of term labour between private and public maternity hospitals in Australia.


METHODS
A population-based study of 789 240 term singleton births in public and private hospitals in 2001-2004, using data from the National Perinatal Data Collection.


METHODS
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.


CONCLUSIONS
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.
Department of Obstetrics and Gynaecology, Australian National University Medical School, Canberra, ACT, Australia. steve.robson@act.gov.au
Stephen J
SJ
Robson
Paula
P
Laws
Elizabeth A
EA
Sullivan
D000328:Adult; D001034:Apgar Score; D001315:Australia / Q000453:epidemiology; D005260:Female; D016304:Hospitals, Private / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007744:Obstetric Labor Complications / Q000453:epidemiology; D010502:Perineum / Q000293:injuries; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000628:therapy; D011256:Pregnancy Outcome; D012151:Resuscitation / Q000706:statistics & numerical data; D018570:Risk Assessment; D055815:Young Adult