Maternal and Neonatal Outcomes and Health System Costs in Standard Public Maternity Care Compared to Private Obstetric‐Led Care: A Population‐Level Matched Cohort Study

Emily J. Callander; Joanne Enticott; Ben W. Mol; Shakila Thangaratinam; Jenny Gamble; Stephen Robson; Helena Teede

doi:10.1111/1471-0528.18286

Maternal and Neonatal Outcomes and Health System Costs in Standard Public Maternity Care Compared to Private Obstetric‐Led Care: A Population‐Level Matched Cohort Study

Emily J. Callander
, Joanne Enticott
, Ben W. Mol
, Shakila Thangaratinam
, Jenny Gamble
, Stephen Robson
, Helena Teede

Research output: Contribution to journal › Article › peer-review

6 Citations (Scopus)

Abstract

Objective We aimed to compare health outcomes and costs in standard public maternity care compared to private obstetric‐led maternity care. Design Observational study with linked administrative data. Setting Australian maternity care. Population 867 334 births, covering all births in three states of Australia between 2016 and 2019. Methods Standard public care involved mainly fragmented midwifery, obstetric and General Practitioner provider care, with birth in a public hospital. Private obstetric‐led care was led by a personally selected obstetrician, with midwifery involvement and birth in a private hospital. We analysed outcomes from pregnancy onset to 4 weeks post‐birth. Matching was utilised to account for demographic, socio‐economic and clinical characteristics. Main Outcome Measures Stillbirths or neonatal deaths; neonatal intensive care admissions; APGAR score < 7 at 5 min; 3rd or 4th degree perineal tears; maternal haemorrhages; mean cost per pregnancy episode. Results Higher adverse outcomes in standard public maternity care compared to private obstetric‐led care, including 778 more stillbirths or neonatal deaths (OR 2.0, 95% CI: 1.8–2.1), 2747 more APGAR score < 7 at 5 min (OR 2.0, 95% CI: 2.0–2.1), 3273 more 3rd or 4th degree perineal tears (OR 2.9, 95% CI: 2.7–3.1) and 10 627 additional maternal haemorrhages (OR 2.7, 95% CI: 2.6–2.8). Mode of birth correlated with neonatal death. Mean cost to all funders in Australian dollars per pregnancy episode was $5929 higher in standard public maternity care. Conclusion We have shown significantly lower adverse health outcomes and costs in private obstetric‐led care compared to standard public maternity care.

Original language	English
Pages (from-to)	72-82
Number of pages	11
Journal	British Journal of Obstetrics and Gynaecology
Volume	133
Issue number	1
Early online date	14 Jul 2025
DOIs	https://doi.org/10.1111/1471-0528.18286
Publication status	Published - Jan 2026

Bibliographical note

© 2025 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/4.0/)
Under this licence, users are permitted to share, download, copy, and redistribute the material in any medium or format, and—where applicable—adapt or build upon the work, provided they comply with the conditions of the stated licence

Funding

Funding: E.J.C., B.W.M. and H.T. received salary support and grant funding from National Health and Medical Research Council (NHMRC) Investigator Grant (APP2009326 and APP1159536 respectively). The authors acknowledge and thank the Consultative Councils Unit and the Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM); the Queensland Statistical Services Branch; the Centre for Health Record Linkage and NSW Ministry of Health for the data and support provided to this project. The opinions and conclusions expressed in this paper are those of the authors and may not reflect those of CCOPMM, Queensland Health, New South Wales Ministry of Health or Victoria Health. The authors also acknowledge and thank for their support with data extraction. Open access publishing facilitated by Monash University, as part of the Wiley - Monash University agreement via the Council of Australian University Librarians. E.J.C., B.W.M. and H.T. received salary support and grant funding from National Health and Medical Research Council (NHMRC) Investigator Grant (APP2009326 and APP1159536 respectively). Funding:

Funders	Funder number
National Health and Medical Research Council	APP1159536, APP2009326

Keywords

maternity
models of care
value

ASJC Scopus subject areas

Obstetrics and Gynaecology

Access to Document

10.1111/1471-0528.18286Licence: CC BY

Gamble2025VoRFinal published version, 626 KBLicence: CC BY

Cite this

Callander, E. J., Enticott, J., Mol, B. W., Thangaratinam, S., Gamble, J., Robson, S., & Teede, H. (2026). Maternal and Neonatal Outcomes and Health System Costs in Standard Public Maternity Care Compared to Private Obstetric‐Led Care: A Population‐Level Matched Cohort Study. British Journal of Obstetrics and Gynaecology, 133(1), 72-82. https://doi.org/10.1111/1471-0528.18286

Maternal and Neonatal Outcomes and Health System Costs in Standard Public Maternity Care Compared to Private Obstetric‐Led Care: A Population‐Level Matched Cohort Study. / Callander, Emily J.; Enticott, Joanne; Mol, Ben W. et al.
In: British Journal of Obstetrics and Gynaecology, Vol. 133, No. 1, 01.2026, p. 72-82.

Research output: Contribution to journal › Article › peer-review

Callander, EJ, Enticott, J, Mol, BW, Thangaratinam, S, Gamble, J, Robson, S & Teede, H 2026, 'Maternal and Neonatal Outcomes and Health System Costs in Standard Public Maternity Care Compared to Private Obstetric‐Led Care: A Population‐Level Matched Cohort Study', British Journal of Obstetrics and Gynaecology, vol. 133, no. 1, pp. 72-82. https://doi.org/10.1111/1471-0528.18286

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abstract = "Objective We aimed to compare health outcomes and costs in standard public maternity care compared to private obstetric‐led maternity care. Design Observational study with linked administrative data. Setting Australian maternity care. Population 867 334 births, covering all births in three states of Australia between 2016 and 2019. Methods Standard public care involved mainly fragmented midwifery, obstetric and General Practitioner provider care, with birth in a public hospital. Private obstetric‐led care was led by a personally selected obstetrician, with midwifery involvement and birth in a private hospital. We analysed outcomes from pregnancy onset to 4 weeks post‐birth. Matching was utilised to account for demographic, socio‐economic and clinical characteristics. Main Outcome Measures Stillbirths or neonatal deaths; neonatal intensive care admissions; APGAR score < 7 at 5 min; 3rd or 4th degree perineal tears; maternal haemorrhages; mean cost per pregnancy episode. Results Higher adverse outcomes in standard public maternity care compared to private obstetric‐led care, including 778 more stillbirths or neonatal deaths (OR 2.0, 95\% CI: 1.8–2.1), 2747 more APGAR score < 7 at 5 min (OR 2.0, 95\% CI: 2.0–2.1), 3273 more 3rd or 4th degree perineal tears (OR 2.9, 95\% CI: 2.7–3.1) and 10 627 additional maternal haemorrhages (OR 2.7, 95\% CI: 2.6–2.8). Mode of birth correlated with neonatal death. Mean cost to all funders in Australian dollars per pregnancy episode was \$5929 higher in standard public maternity care. Conclusion We have shown significantly lower adverse health outcomes and costs in private obstetric‐led care compared to standard public maternity care.",

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Maternal and Neonatal Outcomes and Health System Costs in Standard Public Maternity Care Compared to Private Obstetric‐Led Care: A Population‐Level Matched Cohort Study

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

Access to Document

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