Cost-effectiveness of planned birth in a birth centre compared with alternative planned places of birth: results of the Dutch Birth Centre study

Hitzert, Marit F.; Hermus, Marieke A. A.; Boesveld, Inge C.; Franx, Arie; Bruin, K.M. van der Pal-de; Steegers, Eric A.P.; Marle, M. Elske van den Akker-van

doi:10.1136/bmjopen-2017-016960

Cited by 6 publications

(4 citation statements)

References 40 publications

(42 reference statements)

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“…These women are cared for by independent midwives who attend home births, low-risk hospital births, and births in alongside and free-standing birth centres. The Dutch Birth Centre Study showed that health outcomes, experiences, and costs for low-risk women are similar for planned birth in a birth centre and planned birth in a hospital, both supervised by a primary care midwife [24,25]. Midwives refer women to obstetrician-led care when risks of adverse outcomes increase or complications arise.…”

Section: Introductionmentioning

confidence: 99%

Regional variations in childbirth interventions and their correlations with adverse outcomes, birthplace and care provider: A nationwide explorative study

Seijmonsbergen-Schermers

Zondag

Nieuwenhuijze

et al. 2020

PLoS ONE

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Background Variations in childbirth interventions may indicate inappropriate use. Most variation studies are limited by the lack of adjustments for maternal characteristics and do not investigate variations in adverse outcomes. This study aims to explore regional variations in the Netherlands and their correlations with referral rates, birthplace, interventions, and adverse outcomes, adjusted for maternal characteristics. Methods In this nationwide retrospective cohort study, using a national data register, intervention rates were analysed between twelve regions among single childbirths after 37 weeks' gestation in 2010-2013 (n = 614,730). These were adjusted for maternal characteristics using multivariable logistic regression. Primary outcomes were intrapartum referral, birthplace, and interventions used in midwife-and obstetrician-led care. Correlations both between primary outcomes and between adverse outcomes were calculated with Spearman's rank correlations.

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Section: Introductionmentioning

confidence: 99%

Regional variations in childbirth interventions and their correlations with adverse outcomes, birthplace and care provider: A nationwide explorative study

Seijmonsbergen-Schermers

Zondag

Nieuwenhuijze

et al. 2020

PLoS ONE

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“…Results from cost-effectiveness studies performed in different contexts show a general reduction of cost per birth for MLU models of care. 30,[36][37][38] In our study, the average transfer rate from the MLU to the OU was 23.58%, with a higher transfer rate in labor (21.18%) than postnatally (2.4%). The evidence available shows that transfer rates vary between studies with similar MLU models of care.…”

Section: Discussionmentioning

confidence: 47%

“…The reduction in days of hospitalization could have an influence to the health system, reducing the cost per birth. Results from cost‐effectiveness studies performed in different contexts show a general reduction of cost per birth for MLU models of care 30,36–38 …”

Section: Discussionmentioning

confidence: 99%

The first alongside midwifery unit in Spain: A retrospective cohort study of maternal and neonatal outcomes

Palau‐Costafreda,

García Gumiel,

Eles Velasco

et al. 2023

Birth

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BackgroundMidwife‐led units have been shown to be safer and reduce interventions for women at low risk of complications at birth. In 2017, the first alongside birth center was opened in Spain. The aim of this study was to compare outcomes for women with uncomplicated pregnancies giving birth in the Midwife‐led unit (MLU) and in the Obstetric unit (OU) of the same hospital.MethodsRetrospective cohort study comparing birth outcomes between low‐risk women, depending on their planned place of birth. Data were analyzed with an intention‐to‐treat approach for women that gave birth between January 2018 and December 2020.ResultsA total of 878 women were included in the study, 255 women chose to give birth in the MLU and 623 in the OU. Findings showed that women in the MLU were more likely to have a vaginal birth (91.4%) than in the OU (83.8%) (aOR 2.98 [95%CI 1.62–5.47]), less likely to have an instrumental delivery, 3.9% versus 11.2% (0.25 [0.11–0.55]), to use epidural analgesia, 19.6% versus 77.9% (0.15 [0.04–0.17]) and to have an episiotomy, 7.4% versus 15.4% (0.27 [0.14–0.53]). There were no differences in rates of postpartum hemorrhage, retained placenta, or adverse neonatal outcomes. Intrapartum and postpartum transfer rates from the MLU to the OU were 21.1% and 2.4%, respectively.ConclusionsThe high rate of obstetric interventions in Spain could be reduced by implementing midwife‐led units across the whole system, without an increase in maternal or neonatal complications.

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“…In the Netherlands, low-risk women in primary midwife-led care are cared for by independent midwives who attend home births, low-risk hospital births, and births in alongside and free-standing birth centres. The Dutch Birth Centre Study showed that health outcomes, experiences, and costs for low-risk women are similar for planned birth in a birth centre and planned birth in a hospital, both supervised by a primary care midwife [ 40 , 41 ]. When risks for adverse outcomes increase or complications arise, women are referred to obstetrician-led care.…”

Section: Methodsmentioning

confidence: 99%

Regional variations in childbirth interventions in the Netherlands: a nationwide explorative study

Seijmonsbergen-Schermers

Zondag

Nieuwenhuijze

et al. 2018

BMC Pregnancy Childbirth

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BackgroundAlthough interventions in childbirth are important in order to prevent neonatal and maternal morbidity and mortality, non-indicated use may cause avoidable harm. Regional variations in intervention rates, which cannot be explained by maternal characteristics, may indicate over- and underuse. The aim of this study is to explore regional variations in childbirth interventions in the Netherlands and their associations with interventions and adverse outcomes, controlled for maternal characteristics.MethodsChildbirth intervention rates were compared between twelve Dutch regions, using data from the national perinatal birth register for 2010–2013. All single childbirths from 37 weeks’ gestation onwards were included. Primary outcomes were induction and augmentation of labour, pain medication, instrumental birth, caesarean section (prelabour, intrapartum) and paediatric involvement. Secondary outcomes were adverse neonatal and maternal outcomes. Multivariable logistic regression analyses were used to adjust for maternal characteristics. Associations were expressed in Spearman’s rank correlation coefficients.ResultsMost variation was found for type of pain medication and paediatric involvement. Epidural analgesia rates varied from between 12 and 38% (nulliparous) and from between 5 and 14% (multiparous women). These rates were negatively correlated with rates of other pharmacological pain relief, which varied from between 15 and 43% (nulliparous) and from between 10 and 27% (multiparous). Rates of paediatric involvement varied from between 37 and 60% (nulliparous) and from between 26 and 43% (multiparous). For instrumental vaginal births, rates varied from between 16 and 19% (nulliparous) and from between 3 and 4% (multiparous). For intrapartum caesarean section, the variation was 13–15% and 5–6%, respectively. A positive correlation was found between intervention rates in midwife-led and obstetrician-led care at the onset of labour within the same region. Adverse neonatal and maternal outcomes were not lower in regions with higher intervention rates. Higher augmentation of labour rates correlated with higher rates of severe postpartum haemorrhage.ConclusionsMost variation was found for type of pain medication and paediatric involvement, and least for instrumental vaginal births and intrapartum caesarean sections. Care providers and policy makers should critically audit remarkable variations, since these may be unwarranted. Limited variation for some interventions may indicate consensus for their use. Further research should focus on variations in evidence-based interventions and indications for the use of interventions in childbirth.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1795-0) contains supplementary material, which is available to authorized users.

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Cost-effectiveness of planned birth in a birth centre compared with alternative planned places of birth: results of the Dutch Birth Centre study

Cited by 6 publications

References 40 publications

Regional variations in childbirth interventions and their correlations with adverse outcomes, birthplace and care provider: A nationwide explorative study

Regional variations in childbirth interventions and their correlations with adverse outcomes, birthplace and care provider: A nationwide explorative study

The first alongside midwifery unit in Spain: A retrospective cohort study of maternal and neonatal outcomes

Regional variations in childbirth interventions in the Netherlands: a nationwide explorative study

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