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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2019

Open Access 01-12-2019 | Sectio Ceasarea | Research article

Evidence of overuse? Patterns of obstetric interventions during labour and birth among Australian mothers

Authors: Haylee Fox, Emily Callander, Daniel Lindsay, Stephanie Topp

Published in: BMC Pregnancy and Childbirth | Issue 1/2019

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Abstract

Background

There is global concern for the overuse of obstetric interventions during labour and birth. Of particular concern is the increasing amount of mothers and babies experiencing morbidity and mortality associated with caesarean section compared to vaginal birth. In high-income settings, emerging evidence suggests that overuse of obstetric intervention is more prevalent among wealthier mothers with no medical need of it. In Australia, the rates of caesarean section and other obstetric interventions are rising. These rising rates of intervention have been mirrored by a decreasing rate of unassisted non-instrumental vaginal deliveries. In the context of rising global concern about rising caesarean section rates and the known health effects of caesarean section on mothers and children, we aim to better characterise the use of obstetric intervention in the state of Queensland, Australia by examining the characteristics of mothers receiving obstetric intervention. Identifying whether there is overuse of obstetric interventions within a population is critical to improving the quality, value and appropriateness of maternity care.

Methods

The association between demographic characteristics (at birth) and birth delivery type were compared with chi-square. The percentage of mothers based on their socioeconomic characteristics were reported and differences in percentages of obstetric interventions were compared. Multivariate analysis was undertaken using multiple logistic regression to assess the likelihood of receiving obstetric intervention and having a vaginal (non-instrumental) delivery after accounting for key clinical characteristics.

Results

Indigenous mothers, mothers in major cities and mothers in the wealthiest quintile all had higher percentages of all obstetric interventions and had the lowest percentages of unassisted (non-instrumental) vaginal births. These differences remained even after adjusting for other key sociodemographic and clinical characteristics.

Conclusions

Differences in obstetric practice exist between economic, ethnic and geographical groups of mothers that are not attributable to medical or lifestyle risk factors. These differences may reflect health system, organisational and structural conditions and therefore, a better understanding of the non-clinical factors that influence the supply and demand of obstetric interventions is required.
Footnotes
1
Instrumental vaginal birth is a medically assisted birth with the use of obstetrical instruments – either a vacuum cup or forceps.
 
2
A birth which is achieved solely by the mother’s expulsive efforts requiring no mechanical or surgical assistance.
 
3
Cramer’s V varies between 0 and 1 with < 0.1 denoting a small effect size, 0.1–0.29 a medium effect size and 0.3–0.5 a large effect size.
 
4
The reference group for Indigenous is non-Indigenous, for rurality it is major city and for IRSD it is IRSD 1.
 
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Metadata
Title
Evidence of overuse? Patterns of obstetric interventions during labour and birth among Australian mothers
Authors
Haylee Fox
Emily Callander
Daniel Lindsay
Stephanie Topp
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2019
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-019-2369-5

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