New research reveals women giving birth in public hospitals have higher proportions of spontaneous vaginal births compared to private hospitals, where caesarean sections were more common.
Published in BMJ Open today, the paper, led by Western Sydney University in collaboration with University Medical Center Groningen, Amsterdam University Medical Center, and University of Central Lancaster, provides critical insights into how the mode of a woman's first birth influences second and third births.
The research analysed data from more than 172,000 low-risk women in New South Wales, over a 15-year period between 2001–2016, with a focus on healthy first-time mothers and their subsequent second and third birth (addressed as birth patterns). While the descriptive study utilises women's life course approach to understanding birth patterns, it does not account for individual clinical reasons influencing birth mode choices.
Among women with two births, 55.8 per cent in public hospitals followed a vaginal birth, vaginal birth pattern, compared to 36.8 per cent in private hospitals.
For women with three births, 57.2 per cent in public hospitals experienced a vaginal-vaginal-vaginal sequence, compared to 38.8 per cent in private hospitals.
Co-author of the study Professor Hannah Dahlen, from the University's School of Nursing and Midwifery, and Translational Health Research Institute, says the research sheds light on notable differences between public and private hospital models, as interventions in childbirth have increased over the last few decades.
"Our findings reveal the importance of maximising women's chances of a vaginal birth for the first birth as it impacts what happens in future births," said Professor Dahlen.
"We know that women with an operative birth, that is a vaginal birth using instruments, or a caesarean section, are less likely to have vaginal births subsequently.
"The findings of the study provide valuable insights into how the childbirth experience may shape someone's reproductive life course and in turn enable women to make informed decisions about childbearing. It is time to look at birth as part of a continuing story that is impacted by what has happened before."
This study has shed light on birth outcomes for women, based on their initial mode of birth where they were at low risk for medical complications. The findings reveal that women who had an initial spontaneous vaginal birth have a 91.3 per cent likelihood of having subsequent vaginal births, regardless of whether they delivered in a public or private hospital.
Women who had an initial elective caesarean section had an 81.9 per cent probability of having subsequent elective caesarean births. When comparing probabilities between public and private hospital models, the likelihood of subsequent elective caesarean births was higher in private hospitals (84.9 per cent) compared to public hospitals (76.9 per cent).
For women whose initial birth was an emergency caesarean section, the probability of a subsequent emergency caesarean was 17.9 per cent, while the probability of a subsequent elective caesarean section stood at 67.4 per cent.
Lead author Clinical Epidemiologist Dr Lilian Peters, University Medical Center Groningen (the Netherlands), and Adjunct Fellow at Western Sydney University, said that important differences were observed based on the maternity care funding model.
"Women identified as low-risk and receiving care from private obstetricians were more likely to experience interventions during childbirth compared to women receiving care in the public health system", said Dr Peters.
"The findings have the potential to shape future maternal health studies and models providing important data for healthcare professionals, policymakers, and expectant mothers.
"This highlights the importance of supporting informed birth choices and considering the implications of maternity care models on long-term outcomes for mothers and families."
To read the full paper, 'How does the first index mode of birth in public or private hospitals predict subsequent births? A 16-year Australian population-based linked data study', download here.
