Rates for obstetric intervention among private and public patients in Australia: population based descriptive study

The study by Roberts et al engages us in the important task of
assessing obstetric intervention and maximising benefit whilst minimising
risks.

It is disappointing however that there is little attempt to address
the question of whether higher intervention rates improved outcomes for
mothers or their babies. It is very unusual for workers not to report
rates of stillbirth, neonatal death and admission to neonatal intensive
care units as measures of preinatal outcomes. Certainly these data are
recorded for the NSW Midwives Data collection form upon which this report
is based, and their absence puzzles me. Maternal mortality is also
recorded, but not reported by the authors.

I was also interested in the finding that women delivering in the
public system were twice as likely to sustain third degree tears as their
private counterparts, with no mention made of the incidince of fourth
degree tears. This raises a possiblity contrary to the view put by the
authors that private patients are exposed by interventions to an increased
risk of faecal problems in the long term.

Predictably, this report has received prominent media publicity in
Sydney, and used to further politicise the issue of maternity care. At
least the BMJ should remain a forum for scientific information and I
cannot understand why the article's reviewers did not require at least
some mention of maternal mortality and perinatal morbidity rates,
especially when the paper's conclusions state "information on the outcomes
associated with the various models of care may infleunce (womens') choices