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Adverse outcomes of labour in public and private hospitals in Australia

Michael D Coory, Guan T Koh, Vicki Flenady and Maarten Kamp
Med J Aust 2009; 191 (10): . || doi: 10.5694/j.1326-5377.2009.tb03326.x
Published online: 16 November 2009

To the Editor: In their national analysis, Robson and colleagues found less favourable outcomes among term singleton babies born in public hospitals than in private hospitals.1 Most health services research is non-randomised, and it is unrealistic to expect studies such as this to be as internally valid as a randomised controlled trial.2 As noted by others,3,4 in the absence of randomisation, it is difficult to untangle the myriad differences between mothers, babies, and the care provided in private and public hospitals (ie, the results might be subject to confounding).


  • 1 School of Population Health, University of Queensland, Brisbane, QLD.
  • 2 Queensland Health, Brisbane, QLD.
  • 3 Townsville Hospital, Townsville, QLD.
  • 4 Mater Mothers’ Research Centre, Brisbane, QLD.


Correspondence: m.coory@uq.edu.au

  • 1. Robson SJ, Laws P, Sullivan EA. Adverse outcomes of labour in public and private hospitals in Australia: a population-based descriptive study. Med J Aust 2009; 190: 474-477. <MJA full text>
  • 2. Concato J, Horwitz RI. Beyond randomised versus observational studies. Lancet 2004; 363: 1660-1661.
  • 3. Sutherland GA, Gartland D, Yelland JS, Brown SJ. Adverse outcomes of labour in public and private hospitals in Australia [letter]. Med J Aust 2009; 190: 518. <MJA full text>
  • 4. Watson LF, Davey M-A, Biro MA, King JF. Adverse outcomes of labour in public and private hospitals in Australia [letter]. Med J Aust 2009; 190: 519. <MJA full text>
  • 5. Australian Bureau of Statistics. Census of Population and Housing: Socio-Economic Indexes for Areas, Australia, 2001. Canberra: ABS, 2003. (ABS Cat. No. 2039.0.)
  • 6. Flenady V, King J, Charles A, et al; Perinatal Society of Australia and New Zealand (PSANZ) Perinatal Mortality Group. PSANZ clinical practice guideline for perinatal mortality. Version 2.2, April 2009. Brisbane: PSANZ, 2009. http://www.psanzpnmsig.org/guideline.html (accessed May 2009).
  • 7. Australian Institute of Health and Welfare National Perinatal Statistics Unit. The Australian Maternity Outcomes Surveillance System. http://www.npsu. unsw.edu.au/NPSUweb.nsf/page/AMOSS (accessed May 2009).

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