title: Public and private pregnancy care in Reggio Emilia Province: an observational study on appropriateness of care and delivery outcomes.
abstract: BACKGROUND
  In industrialized countries, improvements have been made in both maternal and newborn health. While attention to antenatal care is increasing, excessive medicalization is also becoming more common.The aim of this study is to compare caesarean section (CS) frequency and ultrasound scan utilization in a public model of care involving both midwives and obstetricians with a private model in which care is provided by obstetricians only.
  
  
  METHODS
  
  
  
  METHODS
  Observational population-based study.
  
  
  METHODS
  Reggio Emilia Province.
  
  
  METHODS
  5957 women resident in the province who delivered between October 2010 and November 2011.
  
  
  METHODS
  CS frequency and ultrasound scan utilization, stillbirths, and other negative perinatal outcomes. Women in the study were searched in the public family and reproductive health clinic medical records to identify those cared for in the public system. Outcomes of the two antenatal care models were compared through multivariate logistic regression adjusting for maternal characteristics and, for CS only, by stratifying by Robson's Group.
  
  
  RESULTS
  Compared to women cared for in private services (N = 3,043), those in public service (N = 2,369) were younger, less educated, more frequently non-Italian, and multiparous. The probability of CS was slightly higher for women cared for by private obstetricians than for those cared for in the public system (31.8% vs. 27.1%; adjusted odds ratio: 1.10; 95% CI: 0.93-1.29): The probability of having more than 3 ultrasound scans was higher in private care (89.6% vs. 49.8%; adjusted odds ratio: 5.11; 95% CI: 4.30-6.08). CS frequency was higher in private care for all Robson's classes except women who underwent CS during spontaneous labour. Among negative perinatal outcomes only a higher risk of pre-term birth was observed for pregnancies cared for in private services.
  
  
  CONCLUSIONS
  The public model provides less medicalized and more guidelines-oriented care than does the private model, with no increase in negative perinatal outcomes.
authors.forename: Laura
authors.initials: L
authors.lastname: Bonvicini
authors.forename: Silvia
authors.initials: S
authors.lastname: Candela
authors.forename: Andrea
authors.initials: A
authors.lastname: Evangelista
authors.forename: Daniela
authors.initials: D
authors.lastname: Bertani
authors.forename: Morena
authors.initials: M
authors.lastname: Casoli
authors.forename: Annarella
authors.initials: A
authors.lastname: Lusvardi
authors.forename: Antonella
authors.initials: A
authors.lastname: Messori
authors.affiliation: Servizio Interaziendale di Epidemiologia, Azienda Unità Sanitaria Locale and IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. paolo.giorgirossi@ausl.re.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Giorgi Rossi
mesh_terms: D000293:Adolescent; D000328:Adult; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007558:Italy; D008427:Maternal Health Services / Q000458:organization & administration*; D018743:Perinatal Care / Q000592:standards*; D011247:Pregnancy; D017149:Private Sector / Q000592:standards*; D017150:Public Sector / Q000592:standards*; D011787:Quality of Health Care; D012189:Retrospective Studies; D055815:Young Adult