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• W949098416 abstract "Editor—Roberts et al found that “there are no obvious clinical reasons for intervention rates to be higher in private than in public patients.”1 There are clinical reasons.In private practice, women are often older, are career oriented, and have private insurance because they can afford it. Roberts et al's analysis verifies this. In addition to there being more intervention in the older age group the authors also show that privately insured women have fewer children, and therefore intervention relates more to a woman's age than her private insurance status. Interestingly, privately insured women had more episiotomies (perhaps proactively) and fewer third degree tears.There is an incremental rise in the risk of intervention with increasing maternal age.2 As older pregnant women are more likely to be insured, Roberts et al's findings are to be expected. Childbirth in older women may reflect a progressive, age related deterioration in myometrial function,2 and this needs to be explored further. The link with intervention is therefore with increased age and not private insurance, age being coincidental and not a cause. Roberts et al's age adjusted rates for obstetric intervention per 100 women are pooled results and do not show the effects of age.Commonly, in all countries the increasing use of caesarean section is accompanied by a decreasing use of instrumental vaginal delivery. As older women become medically aware of the short and long term sequelae of difficult childbirth and their impact on their quality of life, their expectations and demands become greater.3 If, therefore, modern obstetrics can offer women safe, predictable options and a dignified childbirth with minimal perineal trauma they will choose accordingly and are doing so. It is not a question of defending a higher caesarean section rate as King states in his editorial.4 There is a considerable morbidity in vaginal childbirth even without intervention,5 and women are increasingly recognising this.It also needs to be recognised that many of the interventions referred to are consumer driven, and women are exercising their choice. To relate the outcome of childbirth to their insurance status may be not only misleading to the uninformed but also misused, as has already happened in the Australian press.6" @default.
• W949098416 created "2016-06-24" @default.
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• W949098416 date "2001-02-17" @default.
• W949098416 modified "2023-09-23" @default.
• W949098416 title "Obstetric intervention among private and public patients in Australia. Intervention relates more to age than to having private insurance." @default.
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