Evidence of overuse? Patterns of obstetric interventions during labour and birth among Australian mothers

Fox, Haylee, Callander, Emily, Lindsay, Daniel, and Topp, Steph (2019) Evidence of overuse? Patterns of obstetric interventions during labour and birth among Australian mothers. BMC Pregnancy and Childbirth, 19. 226.

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Background: There is global concern for the overuse of obstetric interventions during labour and birth. Of particular concern is the increasing amount of mothers and babies experiencing morbidity and mortality associated with caesarean section compared to vaginal birth. In high-income settings, emerging evidence suggests that overuse of obstetric intervention is more prevalent among wealthier mothers with no medical need of it. In Australia, the rates of caesarean section and other obstetric interventions are rising. These rising rates of intervention have been mirrored by a decreasing rate of unassisted non-instrumental vaginal deliveries. In the context of rising global concern about rising caesarean section rates and the known health effects of caesarean section on mothers and children, we aim to better characterise the use of obstetric intervention in the state of Queensland, Australia by examining the characteristics of mothers receiving obstetric intervention. Identifying whether there is overuse of obstetric interventions within a population is critical to improving the quality, value and appropriateness of maternity care.

Methods: The association between demographic characteristics (at birth) and birth delivery type were compared with chi-square. The percentage of mothers based on their socioeconomic characteristics were reported and differences in percentages of obstetric interventions were compared. Multivariate analysis was undertaken using multiple logistic regression to assess the likelihood of receiving obstetric intervention and having a vaginal (non-instrumental) delivery after accounting for key clinical characteristics.

Results: Indigenous mothers, mothers in major cities and mothers in the wealthiest quintile all had higher percentages of all obstetric interventions and had the lowest percentages of unassisted (non-instrumental) vaginal births. These differences remained even after adjusting for other key sociodemographic and clinical characteristics.

Conclusions: Differences in obstetric practice exist between economic, ethnic and geographical groups of mothers that are not attributable to medical or lifestyle risk factors. These differences may reflect health system, organisational and structural conditions and therefore, a better understanding of the non-clinical factors that influence the supply and demand of obstetric interventions is required.

Item ID: 58849
Item Type: Article (Research - C1)
ISSN: 1471-2393
Keywords: Maternal Health, Obstetrics, Cesarean section, Vaginal birth, Health system
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Copyright Information: © The Author(s). 2019 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Additional Information:

A version of this publication was included as Chapter 3 of the following PhD thesis: Fox, Haylee (2021) Medicalised childbirth: variation in care and drivers of maternal health service provision in Queensland, Australia. PhD thesis, James Cook University, which is available Open Access in ResearchOnline@JCU. Please see the Related URLs for access.

Funders: James Cook University (JCU)
Date Deposited: 07 Jul 2019 22:40
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3215 Reproductive medicine > 321502 Obstetrics and gynaecology @ 50%
42 HEALTH SCIENCES > 4204 Midwifery > 420402 Models of care and place of birth @ 50%
SEO Codes: 92 HEALTH > 9202 Health and Support Services > 920206 Health Policy Economic Outcomes @ 20%
92 HEALTH > 9202 Health and Support Services > 920299 Health and Support Services not elsewhere classified @ 40%
92 HEALTH > 9202 Health and Support Services > 920208 Health Inequalities @ 40%
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