BJOG. 2025 Jul 14. doi: 10.1111/1471-0528.18286. Online ahead of print.
ABSTRACT
OBJECTIVE: We aimed to compare health outcomes and costs in standard public maternity care compared to private obstetric-led maternity care.
DESIGN: Observational study with linked administrative data.
SETTING: Australian maternity care.
POPULATION: 867 334 births, covering all births in three states of Australia between 2016 and 2019.
METHODS: Standard public care involved mainly fragmented midwifery, obstetric and General Practitioner provider care, with birth in a public hospital. Private obstetric-led care was led by a personally selected obstetrician, with midwifery involvement and birth in a private hospital. We analysed outcomes from pregnancy onset to 4 weeks post-birth. Matching was utilised to account for demographic, socio-economic and clinical characteristics.
MAIN OUTCOME MEASURES: Stillbirths or neonatal deaths; neonatal intensive care admissions; APGAR score < 7 at 5 min; 3rd or 4th degree perineal tears; maternal haemorrhages; mean cost per pregnancy episode.
RESULTS: Higher adverse outcomes in standard public maternity care compared to private obstetric-led care, including 778 more stillbirths or neonatal deaths (OR 2.0, 95% CI: 1.8-2.1), 2747 more APGAR score < 7 at 5 min (OR 2.0, 95% CI: 2.0-2.1), 3273 more 3rd or 4th degree perineal tears (OR 2.9, 95% CI: 2.7-3.1) and 10 627 additional maternal haemorrhages (OR 2.7, 95% CI: 2.6-2.8). Mode of birth correlated with neonatal death. Mean cost to all funders in Australian dollars per pregnancy episode was $5929 higher in standard public maternity care.
CONCLUSION: We have shown significantly lower adverse health outcomes and costs in private obstetric-led care compared to standard public maternity care.
PMID:40654027 | DOI:10.1111/1471-0528.18286
