Private patients most likely to opt for c-section

Expectant mothers who opt for private hospital care are almost 50% more likely to pre-book a caesarean section than mothers who choose to have their baby in the public system, according to a study.

However, this is not because they are “too posh to push”, according to Richard Greene, director of the National Perinatal Epidemiology Centre, where the research was carried out.

Instead, it is more likely to be influenced by the need to plan around a career, or by age, with older women sensitive to the risk of increased obstetric complications.

“The private group are a slightly older group and that is definitely a factor that would increase obstetric issues,” said Prof Greene.

There was also the possibility of women being influenced by the choice of celebrity mothers, many of whom opt for C-section births, Prof Greene said.

He said while they did not have strong evidence, it appeared mothers who go private belonged to a higher socio-economic group who were planning life around a career.

Another significant finding of the public versus private study was that among mothers with a natural delivery, those who booked privately were 40% more likely to have an episiotomy — a procedure involving a surgical cut to the opening of the vagina aimed at aiding a difficult delivery.

Prof Greene said they did not know why this was the case. “It’s hard to explain,” he said.

The study, which looked at obstetric intervention rates among mothers who booked privately versus mothers who booked publicly across Ireland between 2005 and 2010, also found a more than 70% increase (from 2.7% to 4.6%) in the rate of forceps delivery among public patients.

Prof Greene said this may be related to the drive to reduce C-section rates which currently stand at around 27% nationally.

However, forceps delivery rates among private patients remained more or less static over the five year period.

Prof Greene, a consultant obstetrician/gynaecologist at Cork University Maternity Hospital, said the research, carried out in the UCC Department of Obstetrics and Gynaecology at the hospital, was largely quantitative but they were considering further research looking at the reasons behind the decision-making.

He said the findings of their research were not significantly “out of kilter” with international studies.

The NPEC study looked at rates of caesarean delivery, operative vaginal delivery, induction of labour and episiotomy in 403,642 childbirths.

Approximately one third of these births (30.2%) were booked privately. Less than one fifth of women opt for private obstetric care at the hospital and out of those who do, a higher proportion are aged 35 to 40.

The findings have been published in online peer- reviewed journal BMC Pregnancy and Childbirth.