Women who go private to give birth more likely to have Caesarean

Women who go private to have their baby are almost three times more likely than public patients to have an elective Caesarean section, according to a study of 75,000 women attending a Dublin maternity hospital.

The increased elective Caesarean rate among private patients is linked in the study of patients at the Coombe Women and Infants’ Hospital to a desire for continuity of care from an obstetrician from women who are “risk-averse”.

Women who opt for private care are more likely to have experienced pregnancy loss, infertility treatment and multiple pregnancies, and are on average more than five years older than public patients, the authors found.

“This suggests that women are choosing private care, in part, because they are more risk-averse for clinical and sociodemographic reasons. They prefer a model of care where there is continuity of care by a senior obstetrician and where they believe they can optimise a good clinical outcome for their baby and themselves.”

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Prof Michael Turner, of the UCD Centre for Human Reproduction at the Coombe hospital, pointed out that many of the women would have received IVF, and having invested "personally and financially" in this technology would be more likely to go privately to an obstetrician for the birth so they got continuity of care and "risk minimisation".

Multiple births

The study involved 73,000 women who had a single pregnancy at the Coombe and 2,000 who had multiple births. It found 75 per cent had public care, 11 per cent semi-private and 14 per cent private.

Overall, 71 per cent of births in the study involved vaginal delivery, 14.5 per cent were elective Caesareans and 14.5 per cent were emergency Caesareans.

Elective Caesareans are typically carried out where a doctor thinks a vaginal delivery might be too difficult, where the baby is in the breech position or where complications have arisen.

Private patients were on average 5.3 years older and were more likely to be Irish-born, married and in professional or managerial employment.

Women with multiple pregnancies were almost twice as likely to go private than those expecting one child (24.6 per cent versus 14.9 per cent).

The elective Caesarean rate in private patients was 29.4 per cent, compared to 11.1 per cent in public patients, but the emergency Caesarean rate was slightly lower – 13.3 per cent versus 14.2 per cent.

Same package

The study, published in BMC Pregnancy and Childbirth journal, also looked at women who returned to the hospital for a second pregnancy, and found 90 per cent chose the same package second time around. Women who switched to private for their second pregnancy were more likely to have had an emergency Caesarean or admission to the neonatal unit the first time.

Rising rates of Caesarean section, in Ireland and internationally, have been a source of concern for many years. The study points out that the operation has become much safer for mothers, even while risk factors have increased due to women having children later, rising obesity levels and increased rates of diabetes.

“It’s a question of balancing the risks and benefits for each individual case. There’s a lot of mythology about the optimum Caesarean rate, when no one knows what it is,” said Prof Turner.

“There is a big difference in the Caesarean rate between private and public patients, but when you correct for clinical risk it shrinks considerably.

“The issue is more complex than it is sometimes portrayed, and people should not apply simplistic, ideological arguments in relation to it.”