Purpose: To examine the regional impact of a shift from public to private hospital care on birthing outcomes.

Procedures: A retrospective regional cohort study analysed the birth outcomes for 20,826 live singleton births of gestation >or=37 weeks, within one regional area in New South Wales between 1 January 1997 and 31 December 2003. Rates of intervention for induction of labour (IOL), epidural pain relief and operative mode of birth were established and analysed according to hospital type. A cascade model was then constructed for total births by hospital type.

Findings: Regional birthing outcomes were significantly affected by a shift from public to private hospital care. The introduction of a new private hospital birth facility in the region studied, led to 90% of all privately insured births within the region shifting to the private hospital. During the period 1997-2003, overall regional rates for IOL increased from 38 to 45%, epidural use in labour increased from 10.4 to 21.1% and the caesarean section rate increased from 14.1 to 24.75%.

Principal conclusions: The introduction of a new private hospital birthing facility into the regional health area studied and the shift from public to private hospital birth had a profound impact on the overall birthing experiences of women in the region. This suggests that private hospital services are not a direct substitute for public hospital birthing services. The cascade effect was present for women regardless of risk category and more pronounced in the private hospital. Women who are privately insured require better information to assist them in choosing their birthing environment, rather than assuming that they are simply buying a comparable product through private insurance.