The rate of Queensland caesarean births in both public and private hospitals does not correlate with women’s preferences to how they birth. 10% of women said they had a pre-existing preference for a caesarean birth – and it’s an equal 10% for private and public patients. However, the rate of caesarean births is almost 50% in the private system, and 30% in public. These numbers beg the question: why the discrepancy?
Dr Yvette Miller of Queensland University of Technology’s Institute of Health and Biomedical Innovation found these results by conducting Queensland Government-funded surveys in 2009, 2010, and 2012. The surveys were of over 14 000 women who had recently given birth in Queensland.
The rate of caesarean birth in Queensland has gone from 25% in 2001 to 33% in 2011, making Queensland the second highest state in Australia for caesarean sections (after WA).
Obstetric doctors provided some reasons they think the rates between private and public are so different – that there were a higher number of older women with more risk factors in the private system, or more women who want a caesarean. But as stated in the opening paragraph – it was found that an equal number of women wanted caesarean births in the first place, though more ended up having them in private than public.
Dr Miller said, according to the survey findings, “Differences in women’s age, obstetric risk, medical complications or education are not driving the higher rates of caesareans in the private sector, nor are women’s preferences…”
It was found that women did not feel they were provided with information about the options for their birth or the right to choose what they wanted. Such comments as below were found:
“While I had the option of either a vaginal or caesarean birth, I felt strongly urged to have a caesarean. I didn’t want to have a caesarean but I decided to, based on two obstetricians strongly advising me to do so.’”
“I was strongly discouraged from having a caesarean in the public system and at this time I found this quite stressful as I didn’t feel I had complete control of all my decisions.”
The survey showed that women birthing in public hospitals were more often looked after by midwives, whereas women in private hospitals were cared for by obstetricians. These professional groups see different risks in each birth option, thus they would recommend different birth options between them.
The cost of caesarean sections is also a factor, as the fees for private caesareans fall on the patient, whereas the fees in the public system fall on the system itself, which causes strain on hospital resources.
These findings call into question suggestions that age, risk factors, and preference are the cause for higher and differing rates of caesarean sections in public versus private. So what is the real reason? The exact answer remains to be seen. While there wasn’t enough evidence to draw a direct link from place of birth with odds of having a caesarean section, it does make you stop to think, doesn’t it?