Obstetric interventions among private and public patients

Papers p 137 Pregnant women in Australia who give birth in private hospitals have higher rates of operative delivery (caesarean sections, forceps procedures, and vacuum extractions) than those who use public hospitals. Do they need to have more caesarean sections? In this edition of the BMJ , Roberts and colleagues (p 137) examine the risk profiles of these two populations among women having babies in New South Wales, Australia.1 They found that similar rates of women were classified as low risk (48% in private hospitals and 49% in public). Within these low risk groups, private patients were more likely to be 30–34 years old, but the proportion of women classed as being at low risk was the same in each group. The authors, therefore, reasonably argue that this counters the commonly held view that the reason for higher rates of caesarean sections in private patients in Australia is because women at higher risk of complications in pregnancy are more likely to take out private insurance for pregnancy …