Comparative Analysis of Obstetric Interventions in Australian Women

This report examines the differences in obstetric interventions and associated neonatal and maternal outcomes between Australian-born women and those born overseas, based on data from New South Wales between 2000 and 2008. The study employs a population-based descriptive design, analyzing data on a sample size of 691,738 singleton births. Key findings include the comparative risks of gestational diabetes mellitus and hypertension. The report highlights the role of factors such as language barriers, economic status, and cultural differences in influencing obstetric intervention rates and outcomes. It also discusses the limitations of the study, particularly regarding the challenges faced by migrant populations and the impact of these factors on healthcare access and delivery. The analysis includes statistical calculations, such as confidence intervals and risk ratios, to quantify the disparities in obstetric intervention rates. The report concludes by emphasizing the need for tailored programs to support high-risk populations, such as Indian-born women, to ensure optimal maternal and neonatal health outcomes.

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Biostatistics and Epidemeology
Student’s Name
Date of Submission

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Q1
The aim off this study was to determine the differences that exists in obstetric
intervention as well as the selected neonatal and mother outcomes in two groups of
Australian women (mothers) 1. The two classes of mothers in this study is the women
born in Australia versus those born in overseas, with the two classes obtaining obstetric
intervention in Australia. This is because, literature indicates that the Australian women
born in overseas face serious challenges such as low birth weight, pre term and cognitive
impaired babies during obstetric interventions 2. These problems are linked to low level
of education, language barrier, low financial status and lack of proper care during
gestation. As such, this study has put into consideration the places of birth of the two
classes of Australian women 3. Based on the factors that predispose the women born in
overseas to birth related problems, the women born in Australia are termed as low risks
women while those born in overseas are the high risk and both are giving birth in New
South Wales between the years 2000 to 2008 1. This was to get the difference in the rates
of obstetric interventions for the mothers and neonates so as to understand the differences
that arise between women born in overseas and those born in Australia during obstetric
care.
Q2
The study design used in this study was the population based descriptive study
among the singleton births in the New South Wales. The data was used was previously
collected by the midwives in the New South Wales. This data was collected between the
years 2000 and 2008, making the sample size to be 691,738 1. Since this data focusses on
the time frame of collection, it makes it possible to answer some specific questions of
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interest in a study, for instance the rate or prevalence of the obstetric intervention in
mothers and neonates among two classes of Australian women giving birth in New South
Wales; that is, the women born in overseas and those born in Australia. One disadvantage
of this research design is that it is expensive especially for the data collection part.
Moreover, since the data collected might also involve the recalling of previous events 4.
This design is crucial for answering a hypothesis because it makes it possible to find out
whether there is or not a relationship between an activity or condition and a health
outcome. This research design also enables researchers to analyze the numerous data
collected over a long period of time to be analyzed to effectively meet the aims of the
researcher.
Q3
Gestational diabetes mellitus:
Australian
Gestational
diabetes mellitus
Yes
15397
Yes
14,630
30,027
No
481,271
no
180,440
661,711
= 15,397/30,027 divided by 481,271/ 661,711
= 0.51/ 0.73
= 0.69
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This indicates that the Australian born women have less risk of developing
gestational diabetes mellitus as compared to the non-Australian born women in obstetric
interventions 1.
Hypertension:
Australian
Hypertension Yes
29,800
Yes
9,168
38,968
No
466,868
no
185,902
652,770
= 29,800/ 38968 divided by 466,868/ 652,770
= 0.76 / 0.71
= 1.07
This indicates that the Australians born women have a higher risk of developing
hypertension as compared to the non Australian born people 5.
Pre- term births:
Australian
Preter
m birth
Yes
29,800
Yes
14,630
38,968
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No
466,868
no
180,440
651,209
= 29,800/ 38,968 divided by 466,868, /651,209
= 0.76/ 0.71
= 1.05
Q4
Excessive risk for gestational diabetes mellitus among the non-Australians
The difference between the gestational diabetes mellitus among the Australians
and non-Australian born women is:
7.5-3.1= 4.4 %
Australian
Excess
Gestational
diabetes
mellitus
Yes
8,583
Yes
14,630
23,213
No
186,487
no
180,440
366,927
= 8,583/ 23,213 divided by 186,487/ 366,927
= 0.37/ 0.51
= 0.73
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This value indicates that there was an excess of 0.73 times risk of developing
gestational diabetes mellitus by the non-Australian born mothers.
Q5
Sample mean= population N / individual observations
= 691,738 divided by 496,668
= 1.39
CI= x±z* sd/square root of n
= 1.39 ± 1.96* 5.59/704.75
= 1.39± 1.96* 0.00793
= 1.39 ± 0.0155
=1.39+0.0155= 1.445
Or
1.39-0.0155= 1.374
Interpretation: in this study therefore, the rate of obstetric intervention,
specifically the maternal ages of the Australian born women is between 1.374 and 1.445
on the bases of the sample data.
Indian born women:
Mean =691,738 divided by 8,301
= 83.33
CI= x±z* sd/square root of n
= 83.33 ± 1.96* 4.29/ 91.11
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= 83.33 ± 1.96* 0.0471
= 83.33 ± 0.092
=83.33 +0.092 = 83.44
Or
83.33 -0.092= 83.24
Interpretation: in this study therefore, the rate of obstetric intervention,
specifically the maternal ages of the Indian born women is between 83.24 and 83.44 on
the bases of the sample data.
Q 6
The confidence interval of the Australian women can be narrower than that of the
Indian born women 6. This is because the Australian born women have lower chances of
their children developing obstetric intervention related problems as compared to the
Indian born women in Australia. While the normal vaginal birth is considered to be
spontaneous and safe, the findings of this study indicated that majority of the Indian born
women in Australia had high chanced of undergoing instrumental delivery and low rates
of spontaneous delivery 7. Since majority of the Indian born women are not able to access
health care from private hospitals, they are not likely to get the best care from public
hospitals and are thus classified under the low risk primiparous group 1. The narrower
95% confidence interval among the Australian born women means that more of these
women receive less obstetric intervention as compared to the Indian born women in
Australia.
Taking a case where the whereby the SD was 1.29 instead of 4.29, this would
mean that there is no much or significant variation between the Australian and the Indian
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born women giving birth in Australia 8. As such, the overall effects of environmental
exposure and country of birth would not have any significant effect on the obstetric
interventions in New South Wales.
Q7
There are a number of limitations highlighted in this study that could be related to
the outcomes of the findings recorded 9. Some of them include migration from an English
speaking country, English fluency, length of residence, and the background of the
residence led to problems such as lack of cultural intensive care. For instance, most of the
Australian refugees were born in English speaking developed countries 10. This means
that English was the language that they used bearing in mind that Australia is not an
English speaking country. This means that there was language barrier, a situation which
created lack of proper communication between health care providers and the patients
(mothers). As a result of this, there is a high likelihood of poor health care services
delivery 11. In other cases, the differences in the background of the refugees created some
culture divergence whereby some Australians, based on their conserved culture might fail
to attend some health care services that might be viewed to be against their cultural
beliefs 7. This could lead to birth of underweight children as well as children with other
defects.
Therefore, these limitations influence the study findings because the Australian
women born overseas will have higher rates of obstetric intervention as well as those of
their children since they do not attend most health education programs, education and
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health care services against their cultural beliefs, low economic status and general
awareness 8.
Q8
Indians are considered to be a high risk population because they are migrants into
Australia. This means that they have been exposed to conditions of language barrier, low
economic status and low level of education among other risk factors 12. As they settle in
Australia, they face the challenges in seeking health care due to their varied cultures and
beliefs. As such, their babies might be prone to health problems like diabetes mellitus,
low cognitive abilities, and low birthweights. This indicates that the Indian born women
should be offered alternative programs to make sure that these mothers as well as their
babies receive the best care in spite of the language, education, cultural and economic
differences that might exists. More so the language barrier may lead to communication
break down between the Indian born women and the health care providers in Australia 8.
The economic gap between these women considering the poverty levels of India may
make some basic health services for the Indian born women to be unaffordable. This is
because the defects that result from obstetric intervention in such women may lead to
increased mortalities and morbidities among their children.
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