Intervention relates more to age than to having private insurance

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 …