Dahlen Hannah Grace, Tracy Sally, Tracy Mark, Bisits Andrew, Brown Chris, Thornton Charlene
School of Nursing and Midwifery, Family and Community Health Research Group, University of Western Sydney, Sydney, New South Wales.
BMJ Open. 2012 Sep 10;2(5). doi: 10.1136/bmjopen-2012-001723. Print 2012.
To compare the risk profile of women giving birth in private and public hospitals and the rate of obstetric intervention during birth compared with previous published rates from a decade ago.
Population-based descriptive study.
New South Wales, Australia.
691 738 women giving birth to a singleton baby during the period 2000 to 2008.
Risk profile of women giving birth in public and private hospitals, intervention rates and changes in these rates over the past decade.
Among low-risk women rates of obstetric intervention were highest in private hospitals and lowest in public hospitals. Low-risk primiparous women giving birth in a private hospital compared to a public hospital had higher rates of induction (31% vs 23%); instrumental birth (29% vs 18%); caesarean section (27% vs 18%), epidural (53% vs 32%) and episiotomy (28% vs 12%) and lower normal vaginal birth rates (44% vs 64%). Low-risk multiparous women had higher rates of instrumental birth (7% vs 3%), caesarean section (27% vs 16%), epidural (35% vs 12%) and episiotomy (8% vs 2%) and lower normal vaginal birth rates (66% vs 81%). As interventions were introduced during labour, the rate of interventions in birth increased. Over the past decade these interventions have increased by 5% for women in public hospitals and by over 10% for women in private hospitals. Among low-risk primiparous women giving birth in private hospitals 15 per 100 women had a vaginal birth with no obstetric intervention compared to 35 per 100 women giving birth in a public hospital.
Low-risk primiparous women giving birth in private hospitals have more chance of a surgical birth than a normal vaginal birth and this phenomenon has increased markedly in the past decade.
比较在私立医院和公立医院分娩的女性的风险状况，以及与十年前公布的比率相比分娩期间的产科干预率。
基于人群的描述性研究。
澳大利亚新南威尔士州。
2000年至2008年期间分娩单胎婴儿的691738名女性。
在公立医院和私立医院分娩的女性的风险状况、干预率以及过去十年中这些比率的变化。
在低风险女性中，产科干预率在私立医院最高，在公立医院最低。与公立医院相比，在私立医院分娩的低风险初产妇引产率更高（31%对23%）；器械助产率更高（29%对18%）；剖宫产率更高（27%对18%），硬膜外麻醉率更高（53%对32%），会阴切开术率更高（28%对12%），正常阴道分娩率更低（44%对64%）。低风险经产妇器械助产率更高（7%对3%），剖宫产率更高（27%对16%），硬膜外麻醉率更高（35%对12%），会阴切开术率更高（8%对2%），正常阴道分娩率更低（66%对81%）。由于分娩过程中采用了干预措施，分娩时的干预率有所增加。在过去十年中，公立医院女性的这些干预措施增加了5%，私立医院女性增加了10%以上。在私立医院分娩的低风险初产妇中，每100名女性中有15名进行了无产科干预的阴道分娩；而在公立医院分娩的每100名女性中有35名。
在私立医院分娩的低风险初产妇进行手术分娩的可能性高于正常阴道分娩，并且这种现象在过去十年中显著增加。
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