Maternal and Neonatal Outcomes and Health System Costs in Standard Public Maternity Care Compared to Private Obstetric-Led Care: A Population-Level Matched Cohort Study.

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.