The rising rates of obstetric interventions (1-3) have been identified as an issue in Australian maternal healthcare reform for over a decade (4-6). This concern is due to the increasing rates of morbidity and mortality (7-13) and the higher costs associated with caesarean section compared to vaginal birth (14)

Callander, Emily

Fox, Haylee

Lindsay, Daniel

Topp, Stephanie

Sydney eScholarship

Population trends and potential policy drivers of the medicalisation of childbirth in AustraliaHaylee Fox1, Associate Professor Emily Callander2, Dr Daniel Lindsay1, Associate Professor Stephanie Topp1.1. College of Public Health, Medical and Veterinary Sciences, James Cook University Townsville2. Centre for Applied Health Economics, School of Medicine, Griffith University BrisbaneBackground – Global Global CS rates have almost doubled                                 in the last 15 years 6.2 million excess CS performed                                globally each                                                       year CS use more frequent in births in the                             richest quintiles ‘Too little too late, too much too soon’Background - Australia0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017Caesarean section Public hospitals Private hospitalsInduction of labour Episiotomies Vaginal delivery (non-instrumental)MethodsData linkage Maternity1000 linked dataset: hospital data; Emergency Department information System; MBS; PBS; Costing records All mothers who gave birth in Queensland between 2012 and 2015 (n=186,789), plus their resultant babies  (n= 189,909) total n=376,698. Population trends Adjusted caesarean section rates in Hospital and Health Service jurisdictions in Queensland Association between socio economic and demographic characteristics and birth delivery type with chi-square analysis Odds Ratios of likelihood of receiving obstetric intervention and having an unassisted vaginal delivery  Confounding variables: pre-existing health condition, maternal age, previous pregnancy complications, complications arising during the current pregnancy, obesity, area-based socioeconomic deprivation, distance from the birthing facility, and smoking Analysis was undertaken using SAS9.4 statistical software.Methodology – scoping review  Scoping review of Australia’s macro level health and financing mechanisms Interpretative synthesis of their impact on the delivery of maternity care Google search engine; targeted websites; academic databasesResultsFigure 1: Caesarean section adjusted percentages by Hospital and Health Service jurisdiction01020304050607080Sociodemographic characteristics of mothers receiving obstetric intervention during labour and birth in Queensland between 01/07/2012 and 30/06/2015Caesarean section Instrumental vaginal birth  Vaginal (non-instrumental) birth Induction of labour Episiotomy EpiduralCesarean section Instrumental vaginal birth Vaginal (non-instrumental) birthInduction of labour Episiotomy EpiduralOR 95%CI OR 95%CI OR 95%CI OR 95%CI OR 95%CI OR 95%CIIndigenous 0.94 0.90 – 0.99 0.70 0.65 - 0.77 1.14 1.09 - 1.19 0.86 0.82 - 0.90 0.65 - 0.80 0.74 0.69 - 0.79Inner Regional 0.96 0.93 – 0.99 0.92 0.88 – 0.97 1.06 1.03 – 1.09 1.10 1.10 - 1.13 0.89 0.84- 0.95 0.98 0.94 – 1.02Outer Regional 1.03 1.00 - 1.06 0.87 0.83 - 0.91 1.01 0.9-1.0.4 1.10 1.07 - 1.14 0.94 0.89 - 1.00 0.79 0.76 - 0.82Remote 1.10 1.05 - 1.15 0.77 0.72 - 0.83 1.00 0.96 - 1.04 1.05 1.00- 1.10 0.88 0.80 – 0.95 0.57 0.54 - 0.61Very remote 1.00 0.95 - 1.10 0.85 0.77 - 0.94 1.05 0.99 - 1.11 1.20 1.17- 1.32 0.85 0.76 – 0.96 0.60 0.55 - 0.66IRSD 1 0.93 0.89 – 0.97 0.80 0.75 – 0.86 1.15 1.10-1.20 0.79 0.75- 0.83 0.63 0.58- 0.69 0.72 0.68 - 0.77IRSD 2 0.95 0.92 – 0.98 0.85 0.81 - 0.89 1.11 1.08 -1.14 0.91 0.88- 0.94 0.70 0.66 - 0.74 0.90 0.86 - 0.94 IRSD 3 0.99 0.96 - 1.03 0.90 0.85 - 0.94 1.04 1.01- 1.08 0.84 0.81- 0.87 0.80 0.75- 0.85 0.96 0.92 – 1.00 IRSD 4 0.88 0.85 - 0.90 0.93 0.89 – 0.97 1.15 1.12 - 1.19 0.95 0.81 – 0.87 0.72 0.75 - 0.85 1.01 0.97 – 1.10 Scoping review1. Privatisation of maternity care 2. Medicalisation of maternity care3. Funding models incentivising volume of care4. Limiting of access midwifery continuity of care modelsPolicy implications – what needs to change? Funding based on quality indicators that preference woman-centred outcomes as opposed to funding models that reward volume What are the links between macro-level financing and hospital- and health provider-level approaches to maternity care? Prioritise publically funded midwifery continuity of carer models

Population trends and potential policy drivers of the medicalisation of birth.

https://ses.library.usyd.edu.au/bitstream/2123/20684/1/Fox%2cHaylee_EHPR%20presentation.pdf

Population trends and potential policy drivers of the medicalisation of birth.

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