Factors associated with changes into public or private maternity care for a second pregnancy

Abstract

The aim of this study was to determine whether outcomes in a first pregnancy were associated with changes into and out of public maternity care. The study population included 155492 women with first and second sequential singleton births, 2000-09 in New South Wales. Analyses were stratified by whether obstetric care for the first birth involved private or public maternity care. Interventions, infant and maternal outcomes were assessed as predictors of a change in care. Adjusted odds ratios for changing care were obtained from logistic regression using backwards elimination. Similar proportions of women changed from private to public care between first and second births (9.6% compared with 9.4% public to private, P-value=0.10). Although interventions (operative delivery, epidural) and outcomes (low Apgar, preterm birth, perinatal death, postpartum haemorrhage, perineal tear and severe maternal morbidity) were all associated with changes from public to private care, only poor infant condition (adjusted odds ratio 1.39, 95% confidence interval 1.15-1.68) was associated with a change from private to public care. The majority of women had consistent care type for both births. This may indicate that women are generally satisfied with care, they rationalise that their first birth care was optimal or they value continuity of carer across pregnancies.