Persisting Rise in Referrals During Labor in Primary Midwife‐led Care in The Netherlands

Offerhaus, Pien; Hukkelhoven, Chantal W.P.M.; Jonge, Ank de; Bruin, K.M. van der Pal-de; Scheepers, P.L.H.; Lagro-Janssen, Antoine L. M.

doi:10.1111/birt.12055

Cited by 48 publications

(55 citation statements)

References 18 publications

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“…Assuming a medium effect size of MBCP compared to the comparison condition and referrals of 30 % from primary to secondary midwifery care due to maladaptation to childbirth [28] we aim to include n =128 pregnant women with a high level of FoC and their partners (64 couples in each arm) to achieve a power of 80 % to find a significant effect (test of between-within interaction, 5 % alpha, 0.5 correlation). We based our power calculations on a medium effect size versus the large effect size found in a single-group trial of MBCP for decreasing pregnancy anxiety ( d = 0.81, p < 0.0001) in the study of Duncan and Bardacke [40] and the overall medium mean effect size of MBP’s ( d = 0.59) [55], in part due to the unknown effect size of the FoCC comparison condition.…”

Section: Methodsmentioning

confidence: 99%

“…However, 47 % of first time Dutch mothers do report fear of childbirth [27]. Maladaptation during childbirth in Dutch women can be seen in the increasing numbers of non-urgent medical referrals during labour [28]. The Dutch midwifery-led model of care assumes that pregnancy, birth and the postnatal period are healthy life events for a mother and her baby.…”

Section: Introductionmentioning

confidence: 99%

“…Overall, almost 60 % of the medical referrals were for non-urgent conditions, such as the need for pain relief, augmentation of labour with oxytocin, or instrumental deliveries due to prolonged labour. However, these referrals did not lead to better child outcomes (such as fewer new-borns with a five-minute Apgar score below 7 or a lower rate of natal or neonatal mortality) when compared with births in primary care [28]. …”

Section: Introductionmentioning

confidence: 99%

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‘I’ve Changed My Mind’, Mindfulness-Based Childbirth and Parenting (MBCP) for pregnant women with a high level of fear of childbirth and their partners: study protocol of the quasi-experimental controlled trial

et al. 2016

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BackgroundApproximately 25 % of pregnant women suffer from a high level of Fear of Childbirth (FoC), as assessed by the Wijma Delivery Expectancy Questionnaire (W-DEQ-A, score ≥66). FoC negatively affects pregnant women’s mental health and adaptation to the perinatal period. Mindfulness-Based Childbirth and Parenting (MBCP) seems to be potentially effective in decreasing pregnancy-related anxiety and stress. We propose a theoretical model of Avoidance and Participation in Pregnancy, Birth and the Postpartum Period in order to explore FoC and to evaluate the underlying mechanisms of change of MBCP.Methods/DesignThe ‘I’ve Changed My Mind’ study is a quasi-experimental controlled trial among 128 pregnant women (week 16–26) with a high level of FoC, and their partners. Women will be allocated to MBCP (intervention group) or to Fear of Childbirth Consultation (FoCC; comparison group). Primary outcomes are FoC, labour pain, and willingness to accept obstetrical interventions. Secondary outcomes are anxiety, depression, general stress, parental stress, quality of life, sleep quality, fatigue, satisfaction with childbirth, birth outcome, breastfeeding self-efficacy and cost-effectiveness. The total study duration for women is six months with four assessment waves: pre- and post-intervention, following the birth and closing the maternity leave period.DiscussionGiven the high prevalence and severe negative impact of FoC this study can be of major importance if statistically and clinically meaningful benefits are found. Among the strengths of this study are the clinical-based experimental design, the extensive cognitive-emotional and behavioural measurements in pregnant women and their partners during the entire perinatal period, and the representativeness of study sample as well as generalizability of the study’s results. The complex and innovative measurements of FoC in this study are an important strength in clinical research on FoC not only in pregnant women but also in their partners.Trial registrationDutch Trial Register (NTR): NTR4302, registration date the 3rd of December 2013.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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‘I’ve Changed My Mind’, Mindfulness-Based Childbirth and Parenting (MBCP) for pregnant women with a high level of fear of childbirth and their partners: study protocol of the quasi-experimental controlled trial

et al. 2016

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“…A referral was considered to be non-urgent if the referral was for a situation that requires diagnostics or treatment in secondary obstetric care, but without emergency. Examples of non-urgent referral reasons are a request for pharmaceutical pain relief, meconium stained liquor without other signs of fetal distress, and lack of progress [9,10]. …”

Section: Methodsmentioning

confidence: 99%

“…Nulliparous woman are referred more often than multiparous women [1-8]. This is also the case in the Netherlands [9,10]. …”

Section: Introductionmentioning

confidence: 99%

Variation in referrals to secondary obstetrician-led care among primary midwifery care practices in the Netherlands: a nationwide cohort study

Offerhaus

Geerts

Jonge

et al. 2015

BMC Pregnancy Childbirth

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BackgroundThe primary aim of this study was to describe the variation in intrapartum referral rates in midwifery practices in the Netherlands. Secondly, we wanted to explore the association between the practice referral rate and a woman’s chance of an instrumental birth (caesarean section or vaginal instrumental birth).MethodsWe performed an observational study, using the Dutch national perinatal database. Low risk births in all primary care midwifery practices over the period 2008–2010 were selected. Intrapartum referral rates were calculated. The referral rate among nulliparous women was used to divide the practices in three tertile groups. In a multilevel logistic regression analysis the association between the referral rate and the chance of an instrumental birth was examined.ResultsThe intrapartum referral rate varied from 9.7 to 63.7 percent (mean 37.8; SD 7.0), and for nulliparous women from 13.8 to 78.1 percent (mean 56.8; SD 8.4). The variation occurred predominantly in non-urgent referrals in the first stage of labour. In the practices in the lowest tertile group more nulliparous women had a spontaneous vaginal birth compared to the middle and highest tertile group (T1: 77.3%, T2:73.5%, T3: 72.0%). For multiparous women the spontaneous vaginal birth rate was 97%. Compared to the lowest tertile group the odds ratios for nulliparous women for an instrumental birth were 1.22 (CI 1.16-1.31) and 1.33 (CI 1.25-1.41) in the middle and high tertile groups. This association was no longer significant after controlling for obstetric interventions (pain relief or augmentation).ConclusionsThe wide variation between referral rates may not be explained by medical factors or client characteristics alone. A high intrapartum referral rate in a midwifery practice is associated with an increased chance of an instrumental birth for nulliparous women, which is mediated by the increased use of obstetric interventions. Midwives should critically evaluate their referral behaviour. A high referral rate may indicate that more interventions are applied than necessary. This may lead to a lower chance of a spontaneous vaginal birth and a higher risk on a PPH. However, a low referral rate should not be achieved at the cost of perinatal safety.

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Integrale geboortezorg – achtergrond, definitie, doelstellingen en organisatorische aspecten

Wildschut

Boesveld²,

Hallensleben

et al. 2018

Integrale Geboortezorg

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Persisting Rise in Referrals During Labor in Primary Midwife‐led Care in The Netherlands

Cited by 48 publications

References 18 publications

‘I’ve Changed My Mind’, Mindfulness-Based Childbirth and Parenting (MBCP) for pregnant women with a high level of fear of childbirth and their partners: study protocol of the quasi-experimental controlled trial

‘I’ve Changed My Mind’, Mindfulness-Based Childbirth and Parenting (MBCP) for pregnant women with a high level of fear of childbirth and their partners: study protocol of the quasi-experimental controlled trial

Variation in referrals to secondary obstetrician-led care among primary midwifery care practices in the Netherlands: a nationwide cohort study

Integrale geboortezorg – achtergrond, definitie, doelstellingen en organisatorische aspecten

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