title: Impact of maternity care policy in Catalonia: a retrospective cross-sectional study of service delivery in public and private hospitals.
abstract: BACKGROUND
  As a result of the growing number of interventions that are now performed in the context of maternity care, health authorities have begun to examine the possible repercussions for service provision and for maternal and neonatal health. In Spain the Strategy Paper on Normal Childbirth was published in 2008, and since then the authorities in Catalonia have sought to implement its recommendations. This paper reviews the current provision of maternity care in Catalonia.
  
  
  METHODS
  This was a descriptive study. Hospitals were grouped according to their source of funding (public or private) and were stratified (across four strata) on the basis of the annual number of births recorded within their respective maternity service. Data regarding the distribution of obstetric professionals were taken from an official government survey of hospitals published in 2010. The data on obstetric interventions (caesarean, use of forceps, vacuum or non-specified instruments) performed in 2007, 2010 and 2012 were obtained by consulting discharge records of 44 public and 20 private hospitals, which together provide care in 98% of all births in Catalonia. Proportions and confidence intervals were calculated for each intervention performed in all full-term (37-42 weeks) singleton births.
  
  
  RESULTS
  Analysis of staff profiles according to the stratification of hospitals showed that almost all the hospitals had more obstetricians than midwives among their maternity care staff. Public hospitals performed fewer caesareans [range between 19.20% (CI 18.84-19.55) and 28.14% (CI 27.73-28.54)] than did private hospitals [range between 32.21% (CI 31.78-32.63) and 39.43% (CI 38.98-39.87)]. The use of forceps has decreased in public hospitals. The use of a vacuum extractor has increased and is more common in private hospitals.
  
  
  CONCLUSIONS
  Caesarean section is the most common obstetric intervention performed during full-term singleton births in Catalonia. The observed trend is stable in the group of public hospitals, but shows signs of a rise among private institutions. The number of caesareans performed in accredited public hospitals covers a limited range with a stable trend. Among public hospitals the highest rate of caesareans is found in non-accredited hospitals with a lower annual number of births.
authors.affiliation: Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain. rescuriet@catsalut.cat.|Directorate-General for Health Planning and Research, Ministry of Health of the Government of Catalonia, Barcelona, Spain. rescuriet@catsalut.cat.
authors.forename: Ramón
authors.initials: R
authors.lastname: Escuriet-Peiró
authors.affiliation: Department of Public Health, Mental Health and Perinatal Nursing, Universitat de Barcelona, Bellvitge Health Sciences Campus, Pavelló de Govern, 3a planta, C/Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain. jgoberna@ub.edu.
authors.forename: Josefina
authors.initials: J
authors.lastname: Goberna-Tricas
authors.affiliation: Directorate-General for Health Planning and Research, Ministry of Health of the Government of Catalonia, Barcelona, Spain. mjpueyo@catsalut.cat.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Pueyo-Sanchez
authors.affiliation: Department of Public Health, Mental Health and Perinatal Nursing, Universitat de Barcelona, Bellvitge Health Sciences Campus, Pavelló de Govern, 3a planta, C/Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain. ngarrico7@alumnes.ub.edu.|Hospital de Manresa, Fundació Althaia, Manresa, Spain. ngarrico7@alumnes.ub.edu.
authors.forename: Neus
authors.initials: N
authors.lastname: Garriga-Comas
authors.affiliation: Department of Public Health, Mental Health and Perinatal Nursing, Universitat de Barcelona, Bellvitge Health Sciences Campus, Pavelló de Govern, 3a planta, C/Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain. iubeda@ub.edu.
authors.forename: Immaculada
authors.initials: I
authors.lastname: Úbeda-Bonet
authors.affiliation: Department of Public Health, Mental Health and Perinatal Nursing, Universitat de Barcelona, Bellvitge Health Sciences Campus, Pavelló de Govern, 3a planta, C/Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain. ccaja@ub.edu.
authors.forename: Carmen
authors.initials: C
authors.lastname: Caja-López
authors.affiliation: Observatory on Women's Health, Subdirectorate for Quality and Cohesion, Ministry of Health, Social Services and Equality, Madrid, Spain. iespiga@msssi.es.
authors.forename: Isabel
authors.initials: I
authors.lastname: Espiga-López
authors.affiliation: Faculty of Economic and Business Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain. vicente.ortun@upf.edu.
authors.forename: Vicente
authors.initials: V
authors.lastname: Ortún-Rubio
mesh_terms: D000068:Accreditation; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005113:Extraction, Obstetrical / Q000706:statistics & numerical data; D005260:Female; D006291:Health Policy; D016304:Hospitals, Private / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008880:Midwifery / Q000706:statistics & numerical data*; D009774:Obstetrics / Q000706:statistics & numerical data*; D011247:Pregnancy; D012189:Retrospective Studies; D013030:Spain; D013525:Surgical Instruments / Q000706:statistics & numerical data; D014620:Vacuum Extraction, Obstetrical / Q000706:statistics & numerical data*; D000078329:Workforce; D055815:Young Adult