Predictors of choice of public and private maternity care among nulliparous women in Ireland,and implications for maternity care and birth experience |
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| Affiliation: | 1. School of Nursing and Midwifery, Trinity College Dublin, Ireland;2. School of Medicine, University College Dublin, Ireland;3. Centre for Health Policy and Management, Trinity College Dublin, Ireland;4. Economics of Palliative Care and Rehabilitation, Cicely Saunders Institute, King’s College London, United Kingdom;1. Centre for Health & Social Care Research, Joint Faculty of Kingston University and St George’s University of London, St George’s University of London, Cranmer Terrace, London SW17 ORE, UK;2. School of Allied Health, Midwifery and Social Care, Joint Faculty of Kingston University and St George’s University of London, St George’s University of London, Cranmer Terrace, London SW17 ORE, UK;1. International School of Economics and Management, Capital University of Economics and Business, Beijing, 100070, PR China;2. Ontario Research Chair in Health Human Resources, Department of Economics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4M4, Canada;3. Centre for Health Economics and Policy (CHEPA), McMaster University, Institute for the Study of Labor (IZA), Bonn, Germany;1. “Carlo F. Dondena” Centre for Research on Social Dynamics and Public Policies, Bocconi University, Via Roentgen, 1, 20136, Milan, Italy;2. Department of Social and Political Sciences, Bocconi University, Via Roentgen, 1, 20136, Milan, Italy;3. Confindustria Economic Research Department, Viale dell’Astronomia, 30, 00144, Rome, Italy;4. Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom;1. Department of Family Practice, University of British Columbia, Vancouver, Canada;2. National Maternity Hospital, Dublin, Ireland;3. School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland;4. Florence Nightingale School of Nursing and Midwifery, King׳s College London, UK;5. Faculty of Health Sciences, University of Southampton, UK;1. University of Central Lancashire, School of Health, Flyde Road, Preston, Lancashire PR12HE, United Kingdom;2. University of Central Lancashire, School of Health, Brook Building, BB224, Flyde Road, Preston, Lancashire PR1 2HE, United Kingdom;1. RCSI Hospitals Group, 111 St Stephen׳s Green, Dublin 2, Ireland;2. National University of Ireland Galway and Saolta University Health Care Group, Ireland;3. Trinity College Dublin, Dublin 2, Ireland;4. The Queen׳s University of Belfast, Northern Ireland, UK |
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| 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. |
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| Keywords: | Maternity care Choice Birth experience Obstetric intervention Risk stratification |
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