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Open Access Research article

Public and private pregnancy care in Reggio Emilia Province: an observational study on appropriateness of care and delivery outcomes

Laura Bonvicini1, Silvia Candela1, Andrea Evangelista2, Daniela Bertani3, Morena Casoli3, Annarella Lusvardi4, Antonella Messori5 and Paolo Giorgi Rossi16*

Author Affiliations

1 Servizio Interaziendale di Epidemiologia, Azienda Unità Sanitaria Locale and IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy

2 Unit of Clinical Epidemiology, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Turin, Italy

3 UO Salute Donna e Infanzia, AUSL of Reggio Emilia, Reggio Emilia, Italy

4 Dipartimento Cure Primarie, AUSL of Scandiano, Scandiano, Italy

5 Programma Materno Infantile, AUSL of Reggio Emilia, Reggio Emilia, Italy

6 Epidemiology Unit, Local Health Trust of Reggio Emilia, via Amendola 2, Reggio Emilia, Italy

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BMC Pregnancy and Childbirth 2014, 14:72  doi:10.1186/1471-2393-14-72

Published: 17 February 2014

Abstract

Background

In industrialized countries, improvements have been made in both maternal and newborn health. While attention to antenatal care is increasing, excessive medicalization is also becoming more common.

The aim of this study is to compare caesarean section (CS) frequency and ultrasound scan utilization in a public model of care involving both midwives and obstetricians with a private model in which care is provided by obstetricians only.

Methods

Design: Observational population-based study. Setting: Reggio Emilia Province. Population: 5957 women resident in the province who delivered between October 2010 and November 2011. Main outcome measures: CS frequency and ultrasound scan utilization, stillbirths, and other negative perinatal outcomes. Women in the study were searched in the public family and reproductive health clinic medical records to identify those cared for in the public system. Outcomes of the two antenatal care models were compared through multivariate logistic regression adjusting for maternal characteristics and, for CS only, by stratifying by Robson’s Group.

Results

Compared to women cared for in private services (N = 3,043), those in public service (N = 2,369) were younger, less educated, more frequently non-Italian, and multiparous. The probability of CS was slightly higher for women cared for by private obstetricians than for those cared for in the public system (31.8% vs. 27.1%; adjusted odds ratio: 1.10; 95% CI: 0.93–1.29): The probability of having more than 3 ultrasound scans was higher in private care (89.6% vs. 49.8%; adjusted odds ratio: 5.11; 95% CI: 4.30–6.08). CS frequency was higher in private care for all Robson’s classes except women who underwent CS during spontaneous labour. Among negative perinatal outcomes only a higher risk of pre-term birth was observed for pregnancies cared for in private services.

Conclusions

The public model provides less medicalized and more guidelines-oriented care than does the private model, with no increase in negative perinatal outcomes.

Keywords:
Pregnancy care; Midwife; Caesarean section; Ultrasound scan