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Public and private pregnancy care in Reggio Emilia Province: an observational study on appropriateness of care and delivery outcomes
Laura Bonvicini, Silvia Candela, Andrea Evangelista, Daniela Bertani, Morena Casoli, Annarella Lusvardi, Antonella Messori5 and Paolo Giorgi Rossi
BMC Pregnancy and Childbirth 2014, 14:72
Editor’s comment: Prof. Jim Thornton: Private pregnancy care increases pre-term birth in Italy
In Reggio Emilia Province in Northern Italy about half of pregnancies are cared for by the private sector (obstetricians alone), and about half in the public sector (shared care by obstetricians and midwives). The former group had more multiple pregnancies but otherwise generally lower risk factors. However, they were more likely to deliver pre-term. The difference remained significant after adjustment for multiple pregnancy and other risk factors.
In industrialized countries, improvements have been made in both maternal and newborn health. While attention to antenatal care is increasing, excessive medicalization is also becoming more common.
The aim of this study is to compare caesarean section (CS) frequency and ultrasound scan utilization in a public model of care involving both midwives and obstetricians with a private model in which care is provided by obstetricians only.
Design: Observational population-based study. Setting: Reggio Emilia Province. Population: 5957 women resident in the province who delivered between October 2010 and November 2011. Main outcome measures: CS frequency and ultrasound scan utilization, stillbirths, and other negative perinatal outcomes. Women in the study were searched in the public family and reproductive health clinic medical records to identify those cared for in the public system. Outcomes of the two antenatal care models were compared through multivariate logistic regression adjusting for maternal characteristics and, for CS only, by stratifying by Robson’s Group.
Compared to women cared for in private services (N = 3,043), those in public service (N = 2,369) were younger, less educated, more frequently non-Italian, and multiparous. The probability of CS was slightly higher for women cared for by private obstetricians than for those cared for in the public system (31.8% vs. 27.1%; adjusted odds ratio: 1.10; 95% CI: 0.93–1.29): The probability of having more than 3 ultrasound scans was higher in private care (89.6% vs. 49.8%; adjusted odds ratio: 5.11; 95% CI: 4.30–6.08). CS frequency was higher in private care for all Robson’s classes except women who underwent CS during spontaneous labour. Among negative perinatal outcomes only a higher risk of pre-term birth was observed for pregnancies cared for in private services.
The public model provides less medicalized and more guidelines-oriented care than does the private model, with no increase in negative perinatal outcomes.