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Objective The aim of this study was to determine whether outcomes in a first pregnancy were associated with changes into and out of public maternity care. Methods The study population included 155 492 women with first and second sequential singleton births, 2000-09 in New South Wales. Analyses were stratified by whether obstetric care for the first birth involved private or public maternity care. Interventions, infant and maternal outcomes were assessed as predictors of a change in care. Adjusted odds ratios for changing care were obtained from logistic regression using backwards elimination. Results Similar proportions of women changed from private to public care between first and second births (9.6% compared with 9.4% public to private, P-value = 0.10). Although interventions (operative delivery, epidural) and outcomes (low Apgar, preterm birth, perinatal death, postpartum haemorrhage, perineal tear and severe maternal morbidity) were all associated with changes from public to private care, only poor infant condition (adjusted odds ratio 1.39, 95% confidence interval 1.15-1.68) was associated with a change from private to public care. Conclusions The majority of women had consistent care type for both births. This may indicate that women are generally satisfied with care, they rationalise that their first birth care was optimal or they value continuity of carer across pregnancies. What is known about the topic? There is some evidence to suggest that interventions and outcomes of one pregnancy are associated with changes in type of delivery, timing of delivery and outcomes of subsequent births. What does this paper add? Obstetric interventions and adverse maternal and infant outcomes were associated with changing maternity care sector and influenced whether or not women remained with the same care provider. What are the implications for practitioners? Continuity of carer may be important to women in choosing their subsequent pregnancy maternity care sector. Most women do not change provider, but first-birth experiences appear to influence those who do change. [ABSTRACT FROM AUTHOR]

Objective. To describe the rates of antenatal hospital admission during twin or higher order multifetal pregnancies, and the admission outcomes as discharge undelivered, transfer to higher care, or spontaneous or elective delivery. Methods. Cohort study using linked birth and hospital data. The cohort comprised women who gave birth to twins or higher order multiple infants of ≥ 24 weeks gestation in 2001--2008 and who were admitted to hospital in weeks 20--36 of the pregnancy. Results. In 63.4% of 10 779 twin pregnancies and 99.5% of 197 triplet and quadruplet pregnancies, the woman was admitted to hospital at least once in weeks 20--36 of the pregnancy, for a total 10 985 admissions. Almost half the admissions (46.3%) ended in discharge without delivery, 10.7% in transfer to higher care, 21.1% in spontaneous labour and birth, and 21.8% in elective delivery (induction or prelabour Caesarean section). The reason for admission was preterm labour in 34.2% of admissions. Conclusions. Hospital admission during pregnancy is common for women with multifetal pregnancies, with many of these admissions resulting in preterm birth. This is the first study to report the rate of pregnancy admissions for women with multifetal pregnancies, and provides a baseline for future studies of hospital use in this population. [ABSTRACT FROM AUTHOR]