Cesarean sections increase healing time and risk of infection or bleeding among mothers. They are also thought to increase the risk of certain medical conditions for infants, such as breathing problems and sudden infant death syndrome (SIDS). Yet, in many parts of the world, the rates continue to sit an all-time high.
Researchers have been working hard to find out why so many C-sections are performed today, looking at everything from vaginal birth after cesarean (VBAC) rates for second or third time parents to parent, doctor and hospital preferences. One recent study that looked at the difference between privately and publicly insured mothers found alarming results.
More than 30,000 Irish women were included in the BMJ Open-published study in which researchers found that patients with private insurance were almost two times more likely to have a cesarean section than those with public health insurance. This was true, despite the fact that women were booked for a singleton birth at the same urban maternity hospital.
Women included in the study delivered sometime between January 2008 and July 2011 at the Irish hospital, which employs about 14 consultants and 16 trainees and births for 8,000 to 9,000 women per year. The researchers said that the differences between the two groups couldn’t be explained by medical and obstetric risks alone. For this reason, they took an in-depth at social, medical, obstetric and financial variables and factors.
Private and public health insurance have both been offered in Irish hospitals for about a decade now. Currently, about 80% of the Irish population has public insurance, while only about 20% have private insurance. However, recent UK policy changes will make it possible for hospitals to bump up the proportion of income that hospitals generate from public health insurance to 49%.
According to the data, 24,574 of the women were publicly insured and 5,479 of them were privately insured. Those that were privately insured were less likely to have a medical disorder, but were more likely to have had a fertility treatment, recurrent miscarriage or experience a stillbirth or infant death. Researchers also found that privately insured women were less likely to be single, childless, have an unplanned pregnancy or to have booked their obstetric care. In addition, privately insured patients tended to be older, more affluent and better educated than publicly insured patients.
Despite the demographics that would suggest they’d be most likely to pursue a vaginal birth because of the benefits, researchers found that privately insured patients were more likely to have a C-section or surgical vaginal delivery (vacuum or forceps). But the greatest disparity was in the rate of planned cesarean births among privately insured patients – a rate that almost doubled those of publicly funded patients. This was especially true for moms that had previously given birth by C-section. Researchers say that these differences remained, even after medical, obstetric and social differences were accounted for.
One theory as to why planned cesareans are so common has to do with the idea that a cesarean birth does less damage to the pelvic floor of the mother. However, while private patients did request more C-sections, this was rarely the reason for the request.
“We found the differences observed in relation to operative deliveries were not explained by higher rates of medical or obstetric complications among private patients,” the authors wrote in the journal. However, they suggested that older age and higher income may have played a part. “Healthcare systems that include public and private patients need to reflect on the potential for disparate rates of intervention and the implications in terms of equity resource use, and income generation.”
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