Predictors of choice of public and private maternity care among nulliparous women in Ireland, and implications for maternity care and birth experience. Issue 5 (May 2020)

• Record Type: Journal Article
• Authors: Moran, Patrick S.; Daly, Deirdre; Wuytack, Francesca; Carroll, Margaret; Turner, Michael; Normand, Charles; Begley, Cecily
• Is Part Of: Health policy. Volume 124:Issue 5(2020)
• Page Start: 556
• Page End: 562
• Publication Date: 2020-05
• Subjects: Maternity care -- Choice -- Birth experience -- Obstetric intervention -- Risk stratification; Medical education -- Periodicals; Medical policy -- Periodicals; Delivery of Health Care -- Periodicals; Education, Medical -- Periodicals; Health Education -- Periodicals; Health Planning -- Periodicals; Public Policy -- Periodicals; Enseignement médical -- Périodiques; Politique sanitaire -- Périodiques; Medical education; Medical policy; Periodicals; Electronic journals; Electronic journals; 362.1
• DOI: 10.1016/j.healthpol.2020.02.008
• Languages: English
• ISSNs: 0168-8510

Abstract

Highlights: Pregnant women in Ireland can choose between free public, or fee-based private, maternity care. Private care is characterised by greater continuity of consultant delivered care. Women at elevated risk in early pregnancy are not more likely to choose private care. Despite this, private care is associated with higher intervention rates and longer hospital stays. Elevated risk in early pregnancy was associated with poorer birth experience outcomes in public, but not private, care. Abstract: Maternity care in Ireland is provided through a mixture of free public and fee-based private or semi-private services. We examined factors associated with choice of care pathway among nulliparous women and how this influences the care they receive and their experience of childbirth using data from a prospective cohort study. Complete data were available for 1, 789 women on choice of care pathway and birth outcomes, and for 1, 336 women on birth experience. Maternal age (marginal effect [ME] 1.6 percentage points [ppts], p < 0.01), socioeconomic status (ME 0.5ppts, p < 0.01) and being born in Ireland (ME 10.3ppts, p < 0.01) were all positively associated with choosing private care, but level of risk in early pregnancy did not influence this decision. Intervention rates in public and semi-private care were comparable, but women in private care were more likely to receive epidural anaesthesia (odds ratio [OR] 1.65, p < 0.01) and give birth by caesarean section (ratio of relative risks [RRR] 1.98, p < 0.01). Private care was also associated with longer hospital stays (28 % longer, p < 0.01). Increased risk was negatively correlated with birth experience in public and semi-private care, but not in private care. Policies promoting the allocation of maternity care resources by level of risk, along with the standardisation of clinical practice across care pathways, could reduce rates of obstetric intervention and address risk-based disparities in birth experience outcomes.