Abstract
BackgroundIn industrialized countries, improvements have been made in both maternal and newborn health. While attention to antenatal care is increasing, excessive medicalization is also becoming more common.The aim of this study is to compare caesarean section (CS) frequency and ultrasound scan utilization in a public model of care involving both midwives and obstetricians with a private model in which care is provided by obstetricians only.MethodsDesign: Observational population-based study. Setting: Reggio Emilia Province. Population: 5957 women resident in the province who delivered between October 2010 and November 2011. Main outcome measures: CS frequency and ultrasound scan utilization, stillbirths, and other negative perinatal outcomes. Women in the study were searched in the public family and reproductive health clinic medical records to identify those cared for in the public system. Outcomes of the two antenatal care models were compared through multivariate logistic regression adjusting for maternal characteristics and, for CS only, by stratifying by Robson’s Group.ResultsCompared to women cared for in private services (N = 3,043), those in public service (N = 2,369) were younger, less educated, more frequently non-Italian, and multiparous. The probability of CS was slightly higher for women cared for by private obstetricians than for those cared for in the public system (31.8% vs. 27.1%; adjusted odds ratio: 1.10; 95% CI: 0.93–1.29): The probability of having more than 3 ultrasound scans was higher in private care (89.6% vs. 49.8%; adjusted odds ratio: 5.11; 95% CI: 4.30–6.08). CS frequency was higher in private care for all Robson’s classes except women who underwent CS during spontaneous labour. Among negative perinatal outcomes only a higher risk of pre-term birth was observed for pregnancies cared for in private services.ConclusionsThe public model provides less medicalized and more guidelines-oriented care than does the private model, with no increase in negative perinatal outcomes.
Highlights
In industrialized countries, improvements have been made in both maternal and newborn health
Study population The study considered all deliveries between 01 October 2010 and 30 November 2011 of women resident in the Province of Reggio Emilia, Emilia-Romagna Region, who were registered in the Birth Certificate (BC) database
Through the comparison between the categorization of model of care deduced by record linkage and the one registered in the BC database, three different exposure groups were defined (Figure 1)
Summary
Improvements have been made in both maternal and newborn health. The aim of this study is to compare caesarean section (CS) frequency and ultrasound scan utilization in a public model of care involving both midwives and obstetricians with a private model in which care is provided by obstetricians only. Pregnancy is a physiological process, the mother’s and/or newborn’s health can at times be at risk. The rate of caesarean sections (CS) is increasing in all industrialized countries [1]. The rising CS rate can be attributed to a range of factors that include the perception that CS is a safe procedure, the lack of awareness of its possible adverse consequences, an increasing proportion of complicated pregnancies, medicolegal concerns, and women’s preferences [7] Despite the recommendations of the World Health Organization (WHO) [2,3] and of the Italian government [4] to reduce CS, the percentage of CS in Italy has risen from 11% in 1980 [5] to 37.5% in 2010 [6].
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