title: A retrospective cohort study of mode of delivery among public and private patients in an integrated maternity hospital setting.
abstract: OBJECTIVE
  To examine the associations between mode of delivery and public versus privately funded obstetric care within the same hospital setting.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Urban maternity hospital in Ireland.
  
  
  METHODS
  A total of 30 053 women with singleton pregnancies who delivered between 2008 and 2011.
  
  
  METHODS
  The study population was divided into those who booked for obstetric care within the public (n=24 574) or private clinics (n=5479). Logistic regression analyses were performed to examine the associations between operative delivery and type of care, adjusting for potential confounding factors.
  
  
  METHODS
  Caesarean section (scheduled or emergency), operative vaginal delivery (vacuum or forceps), indication for caesarean section as classified by the operator.
  
  
  RESULTS
  Compared with public patients, private patients were more likely to be delivered by caesarean section (34.4% vs 22.5%, OR 1.81; 95% CI 1.70 to 1.93) or operative vaginal delivery (20.1% vs 16.5%, OR 1.28; 95% CI 1.19 to 1.38). The greatest disparity was for scheduled caesarean sections; differences persisted for nulliparous and parous women after controlling for medical and social differences between the groups (nulliparous 11.9% vs 4.6%, adjusted (adj) OR 1.82; 95% CI 1.49 to 2.24 and parous 26% vs 12.2%, adj OR 2.08; 95% CI 1.86 to 2.32). Scheduled repeat caesarean section accounted for most of the disparity among parous patients. Maternal request per se was an uncommonly reported indication for caesarean section (35 in each group, p<0.000).
  
  
  CONCLUSIONS
  Privately funded obstetric care is associated with higher rates of operative deliveries that are not fully accounted for by medical or obstetric risk differences.
authors.affiliation: Department of Obstetrics and Gynaecology, Trinity College, University of Dublin, Dublin, Republic of Ireland.
authors.forename: Deirdre J
authors.initials: DJ
authors.lastname: Murphy
authors.forename: Tom
authors.initials: T
authors.lastname: Fahey
keywords: Caesarean Section; Cohort Study; Operative Delivery; Operative Vaginal Delivery; Private Healthcare