title: Private health care coverage and increased risk of obstetric intervention.
abstract: BACKGROUND
  When clinically indicated, common obstetric interventions can greatly improve maternal and neonatal outcomes. However, variation in intervention rates suggests that obstetric practice may not be solely driven by case criteria.
  
  
  METHODS
  Differences in obstetric intervention rates by private and public status in Ireland were examined using nationally representative hospital discharge data. A retrospective cohort study was performed on childbirth hospitalisations occurring between 2005 and 2010. Multivariate logistic regression analysis with correction for the relative risk was conducted to determine the risk of obstetric intervention (caesarean delivery, operative vaginal delivery, induction of labour or episiotomy) by private or public status while adjusting for obstetric risk factors.
  
  
  RESULTS
  403,642 childbirth hospitalisations were reviewed; approximately one-third of maternities (30.2%) were booked privately. After controlling for relevant obstetric risk factors, women with private coverage were more likely to have an elective caesarean delivery (RR: 1.48; 95% CI: 1.45-1.51), an emergency caesarean delivery (RR: 1.13; 95% CI: 1.12-1.16) and an operative vaginal delivery (RR: 1.25; 95% CI: 1.22-1.27). Compared to women with public coverage who had a vaginal delivery, women with private coverage were 40% more likely to have an episiotomy (RR: 1.40; 95% CI: 1.38-1.43).
  
  
  CONCLUSIONS
  Irrespective of obstetric risk factors, women who opted for private maternity care were significantly more likely to have an obstetric intervention. To better understand both clinical and non-clinical dynamics, future studies of examining health care coverage status and obstetric intervention would ideally apply mixed-method techniques.
authors.affiliation: National Perinatal Epidemiology Centre, Cork University Maternity Hospital, Wilton, Cork, Ireland. J.Lutomski@ucc.ie.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Lutomski
authors.forename: Michael
authors.initials: M
authors.lastname: Murphy
authors.forename: Declan
authors.initials: D
authors.lastname: Devane
authors.forename: Sarah
authors.initials: S
authors.lastname: Meaney
authors.forename: Richard A
authors.initials: RA
authors.lastname: Greene
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D004630:Emergencies; D004841:Episiotomy / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000145:classification / Q000706:statistics & numerical data*; D007494:Ireland; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D014620:Vacuum Extraction, Obstetrical / Q000706:statistics & numerical data; D055815:Young Adult