Pregnant women who opt for private maternity care are more likely to have a caesarean section than women who opt for public care, a new Irish study has found.

According to researchers from the National Perinatal Epidemiology Centre (NPEC) in University College Cork, while obstetric interventions, such as caesareans, may be necessary for the health and safety of certain mothers and babies, the choice to perform such interventions ‘can be affected by non-clinical reasons'.

The researchers decided to compare intervention rates among pregnant women who had gone private and those who had gone public in Ireland between 2005 and 2010. They looked at over 403,000 births, almost one in three of which was booked privately.

The study found that overall, women who booked to go private were 48% more likely to have an elective caesarean section. They were also 13% more likely to have an emergency caesarean and 25% more likely to have an assisted delivery, i.e. the use of forceps or a vacuum.

Among women who had a vaginal birth, those who were booked privately were 40% more likely to have an episiotomy.

An episiotomy is a surgical cut that is made to a woman's perineum - the area between the opening of the vagina and the anus (back passage). It used to be relatively common in childbirth as doctors believed it could benefit the woman by, for example, reducing the risk of more extensive vaginal tears during childbirth.

However, research has shown that this is not the case and the procedure should only be carried out in certain circumstances, for example, if the baby is distressed and needs to be born quickly, but the vagina is not stretching enough to allow this.

The researchers concluded that ‘irrespective of obstetric risk factors, women who opted for private maternity care were significantly more likely to have an obstetric intervention'. They insisted that further studies are needed to better understand both the clinical and non-clinical reasons contributing to these differences.

"To provide the best quality maternity care, we need to understand differences in obstetric practice and avoid unnecessary risks. It is important that mums are aware of the benefits and risks of different obstetric procedures and feel open to discuss these issues with their maternity care providers," commented the study's chief author, Jennifer Lutomski, of the NPEC.

Details of these findings are published in the journal, BMC Pregnancy and Childbirth.

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