Maternal and Neonatal Outcomes and Health System Costs in Standard Public Maternity Care Compared to Private Obstetric-Led Care: A Population-Level Matched Cohort Study.

Callander, EJ; Enticott, J; Mol, BW; Thangaratinam, S; Gamble, J; Robson, S; Teede, H

Maternal and Neonatal Outcomes and Health System Costs in Standard Public Maternity Care Compared to Private Obstetric-Led Care: A Population-Level Matched Cohort Study.

Callander, EJ Enticott, J Mol, BW Thangaratinam, S Gamble, J Robson, S Teede, H

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Publisher:: WILEY
Publication Type:: Journal Article
Citation:: BJOG, 2025
Issue Date:: 2025-07-14

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Field	Value	Language
dc.contributor.author	Callander, EJ
dc.contributor.author	Enticott, J
dc.contributor.author	Mol, BW
dc.contributor.author	Thangaratinam, S
dc.contributor.author	Gamble, J
dc.contributor.author	Robson, S
dc.contributor.author	Teede, H
dc.date.accessioned	2025-07-25T02:26:46Z
dc.date.available	2025-06-26
dc.date.available	2025-07-25T02:26:46Z
dc.date.issued	2025-07-14
dc.identifier.citation	BJOG, 2025
dc.identifier.issn	1470-0328
dc.identifier.issn	1471-0528
dc.identifier.uri	http://hdl.handle.net/10453/188840
dc.description.abstract	OBJECTIVE: We aimed to compare health outcomes and costs in standard public maternity care compared to private obstetric-led maternity care. DESIGN: Observational study with linked administrative data. SETTING: Australian maternity care. POPULATION: 867 334 births, covering all births in three states of Australia between 2016 and 2019. METHODS: Standard public care involved mainly fragmented midwifery, obstetric and General Practitioner provider care, with birth in a public hospital. Private obstetric-led care was led by a personally selected obstetrician, with midwifery involvement and birth in a private hospital. We analysed outcomes from pregnancy onset to 4 weeks post-birth. Matching was utilised to account for demographic, socio-economic and clinical characteristics. MAIN OUTCOME MEASURES: Stillbirths or neonatal deaths; neonatal intensive care admissions; APGAR score < 7 at 5 min; 3rd or 4th degree perineal tears; maternal haemorrhages; mean cost per pregnancy episode. RESULTS: Higher adverse outcomes in standard public maternity care compared to private obstetric-led care, including 778 more stillbirths or neonatal deaths (OR 2.0, 95% CI: 1.8-2.1), 2747 more APGAR score < 7 at 5 min (OR 2.0, 95% CI: 2.0-2.1), 3273 more 3rd or 4th degree perineal tears (OR 2.9, 95% CI: 2.7-3.1) and 10 627 additional maternal haemorrhages (OR 2.7, 95% CI: 2.6-2.8). Mode of birth correlated with neonatal death. Mean cost to all funders in Australian dollars per pregnancy episode was $5929 higher in standard public maternity care. CONCLUSION: We have shown significantly lower adverse health outcomes and costs in private obstetric-led care compared to standard public maternity care.
dc.language	eng
dc.publisher	WILEY
dc.relation	http://purl.org/au-research/grants/nhmrc/1159536
dc.relation.ispartof	BJOG
dc.relation.isbasedon	10.1111/1471-0528.18286
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	11 Medical and Health Sciences
dc.subject.classification	Obstetrics & Reproductive Medicine
dc.subject.classification	3215 Reproductive medicine
dc.title	Maternal and Neonatal Outcomes and Health System Costs in Standard Public Maternity Care Compared to Private Obstetric-Led Care: A Population-Level Matched Cohort Study.
dc.type	Journal Article
utslib.location.activity	England
utslib.for	11 Medical and Health Sciences
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Health
pubs.organisational-group	University of Technology Sydney/Faculty of Health/School of Public Health
utslib.copyright.status	open_access	*
dc.rights.license	This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/
dc.date.updated	2025-07-25T02:26:45Z
pubs.publication-status	Published online

Abstract:

OBJECTIVE: We aimed to compare health outcomes and costs in standard public maternity care compared to private obstetric-led maternity care. DESIGN: Observational study with linked administrative data. SETTING: Australian maternity care. POPULATION: 867 334 births, covering all births in three states of Australia between 2016 and 2019. METHODS: Standard public care involved mainly fragmented midwifery, obstetric and General Practitioner provider care, with birth in a public hospital. Private obstetric-led care was led by a personally selected obstetrician, with midwifery involvement and birth in a private hospital. We analysed outcomes from pregnancy onset to 4 weeks post-birth. Matching was utilised to account for demographic, socio-economic and clinical characteristics. MAIN OUTCOME MEASURES: Stillbirths or neonatal deaths; neonatal intensive care admissions; APGAR score < 7 at 5 min; 3rd or 4th degree perineal tears; maternal haemorrhages; mean cost per pregnancy episode. RESULTS: Higher adverse outcomes in standard public maternity care compared to private obstetric-led care, including 778 more stillbirths or neonatal deaths (OR 2.0, 95% CI: 1.8-2.1), 2747 more APGAR score < 7 at 5 min (OR 2.0, 95% CI: 2.0-2.1), 3273 more 3rd or 4th degree perineal tears (OR 2.9, 95% CI: 2.7-3.1) and 10 627 additional maternal haemorrhages (OR 2.7, 95% CI: 2.6-2.8). Mode of birth correlated with neonatal death. Mean cost to all funders in Australian dollars per pregnancy episode was $5929 higher in standard public maternity care. CONCLUSION: We have shown significantly lower adverse health outcomes and costs in private obstetric-led care compared to standard public maternity care.

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http://hdl.handle.net/10453/188840