Too early to question effectiveness of Dutch system

Jonge, Ank de; Mol, Ben Willem J.; Goes, B.Y. van der; Nijhuis, Jan G.; Post, Joris A. M. van der; Buitendijk, S. E.

doi:10.1136/bmj.c7020

Cited by 14 publications

(15 citation statements)

References 4 publications

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“…The results of this study, based on recent data, a larger study group and proper adjustment methods, differ from those of previous publications regarding intrapartum and neonatal mortality in low‐risk and high‐risk women in the Netherlands. These studies performed in the Amsterdam en Utrecht region of the Netherlands, as discussed in our introduction, suggested increased risk intrapartum and neonatal mortality in the midwife‐led care group . Although our previous Amsterdam study showed perinatal mortality rates of 0.75‰ and 0.19‰ for midwife‐led and obstetrician‐led care, respectively, the current study showed ranges between 0.49‰ and 0.44‰ for both groups, which suggests an improvement for the midwife‐led group but a poorer outcome for the obstetrician‐led care group.…”

Section: Discussioncontrasting

confidence: 52%

“…Midwife‐led care therefore includes home births and midwife‐led hospital births (using intermittent auscultation), whereas obstetrician‐led care is always set in a hospital (using fetal trace monitoring with cardiotocography). Previous studies in the Utrecht and Amsterdam regions of the Netherlands showed conflicting results when comparing perinatal mortality in women who started labor in midwife‐led vs obstetrician‐led care …”

Section: Introductionmentioning

confidence: 97%

“…We repeated this study in the Amsterdam region (from 2005 to 2008) and found no significant difference in intrapartum and neonatal mortality rates between groups (0.70‰ in midwife‐led group vs 0.80‰ in obstetrician‐led group; unadjusted relative risk 0.88, 95% CI 0.52‐1.46) . However, evaluating these groups by start of labor is challenging, mostly because of the differences in patient characteristics in midwife‐led and obstetrician‐led care, lack of power (due to low mortality rates among term pregnancies in a regional cohort) and the data quality of the registry data to define, for example, line of care at the start of labor and low‐risk status …”

Section: Introductionmentioning

confidence: 99%

“…The safety of the Dutch obstetric system has been a subject of debate for many years . The typical obstetric system in the Netherlands is characterized by a formal distinction between independent midwife‐led care and obstetrician‐led care.…”

Section: Introductionmentioning

confidence: 99%

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Intrapartum and neonatal mortality in low‐risk term women in midwife‐led care and obstetrician‐led care at the onset of labor: A national matched cohort study

Wiegerinck

Eskes

Post

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Midwife‐led models of care have been the subject of debate for many years. We conducted a study to compare intrapartum and neonatal mortality rates in midwife‐led (primary) vs obstetrician‐led (secondary) care at the onset of labor in low‐risk term women. Material and methods We performed an unmatched and a propensity score matched cohort study using data from the national perinatal audit registry (PAN) and from the national perinatal registry (PERINED) of the Netherlands. We included women with singleton pregnancies (without congenital anomalies or antepartum fetal death) who gave birth at term between 2010 and 2012. We excluded the following major risk factors: non‐vertex position of the fetus, previous cesarean birth, hypertension, diabetes mellitus, prolonged rupture of membranes (≥24 hours), vaginal bleeding in the second half of pregnancy, nonspontaneous start of labor and post‐term pregnancy (≥42 weeks). The primary outcome was intrapartum or neonatal mortality up to 28 days after birth. Secondary outcome measures were mode of delivery and a 5‐minute Apgar score <7. Results We included 259 211 women. There were 100/206 642 (0.48‰) intrapartum and neonatal deaths in the midwife group and 23/52 569 (0.44‰) in the obstetrician group (odds ratio [OR] 1.11, 95% CI 0.70‐1.74). Propensity score matched analysis showed mortality rates of 0.49‰ (26/52 569) among women in midwife‐led care and 0.44‰ (23/52 569) for women in obstetrician‐led care (OR 1.13, 95% CI 0.65‐1.98). In the midwife group there were significantly lower rates of vaginal instrumental deliveries (8.4% vs 13.0%; matched OR 0.65, 95% CI 0.62‐0.67) and intrapartum cesarean sections (2.6% vs 8.2%; matched OR 0.32, 95% CI 0.30‐0.34), and fewer neonates with low Apgar scores (<7 after 5 minutes) (0.69% vs 1.11%; matched OR 0.61, 95% CI 0.53‐0.69). Conclusions Among low‐risk term women, there were comparable intrapartum and neonatal mortality rates for women starting labor in midwife‐led vs obstetrician‐led care, with lower intervention rates and fewer low Apgar scores in the midwife group.

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Section: Discussioncontrasting

confidence: 52%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Intrapartum and neonatal mortality in low‐risk term women in midwife‐led care and obstetrician‐led care at the onset of labor: A national matched cohort study

Wiegerinck

Eskes

Post

et al. 2019

Acta Obstet Gynecol Scand

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“…We did not answer the question of whether the definition of ‘low risk’ was appropriate in our studies. One Dutch study showed a higher perinatal mortality rate among term births that started in primary versus secondary care, regardless of the planned place of birth; however, methodological difficulties in this study complicate the interpretation of the results . For example, information for the numerator and the denominator was collected in different ways and did not come from the same population.…”

Section: Discussionmentioning

confidence: 93%

Perinatal mortality and morbidity up to 28 days after birth among 743 070 low-risk planned home and hospital births: a cohort study based on three merged national perinatal databases

Jonge

Geerts

Goes³

et al. 2014

BJOG: Int J Obstet Gy

130

109

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Objective To compare rates of adverse perinatal outcomes between planned home births versus planned hospital births.Design A nationwide cohort study.Setting The Netherlands.Population Low-risk women in midwife-led care at the onset of labour.Methods Analysis of national registration data.Main outcome measures Intrapartum and neonatal death, Apgar scores, and admission to a neonatal intensive care unit (NICU) within 28 days of birth.Results Of the total of 814 979 women, 466 112 had a planned home birth and 276 958 had a planned hospital birth. For 71 909 women, their planned place of birth was unknown. The combined intrapartum and neonatal death rates up to 28 days after birth, including cases with discrepancies in the registration of the moment of death, were: for nulliparous women, 1.02& for planned home births versus 1.09& for planned hospital births, adjusted odds ratio (aOR) 0.99, 95% confidence interval (95% CI) 0.79-1.24; and for parous women, 0.59& versus 0.58&, aOR 1.16, 95% CI 0.87-1.55. The rates of NICU admissions and low Apgar scores did not significantly differ among nulliparous women (NICU admissions up to 28 days, 3.41& versus 3.61&, aOR 1.05, 95% CI 0.92-1.18). Among parous women the rates of Apgar scores below seven and NICU admissions were significantly lower among planned home births (NICU admissions up to 28 days, 1.36 versus 1.95&, aOR 0.79, 95% CI 0.66-0.93).Conclusions We found no increased risk of adverse perinatal outcomes for planned home births among low-risk women. Our results may only apply to regions where home births are well integrated into the maternity care system.

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Development of the Childbirth Perception Scale (CPS): perception of delivery and the first postpartum week

Truijens

Wijnen

Pommer

et al. 2014

Arch Womens Ment Health

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Document VersionPublisher's PDF, also known as Version of Record (includes final page, issue and volume numbers)Please check the document version of this publication:• A submitted manuscript is the author's version of the article upon submission and before peer-review. There can be important differences between the submitted version and the official published version of record. People interested in the research are advised to contact the author for the final version of the publication, or visit the DOI to the publisher's website.• The final author version and the galley proof are versions of the publication after peer review.• The final published version features the final layout of the paper including the volume, issue and page numbers. General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. Link to publication• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal ? Take down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Abstract Some caregivers suggest a more positive experience of childbirth when giving birth at home. Since properly developed instruments that assess women's perception of delivery and the early postpartum are missing, the aim of the current study is to develop a Childbirth Perception Scale (CPS). Three focus groups with caregivers, pregnant women, and women who recently gave birth were conducted. Psychometric properties of 23 candidate items derived from the interviews were tested with explorative factor analysis (EFA) (N=495). Confirmatory factor analysis (CFA) was performed in another sample of women (N=483) and confirmed a 12-item CPS. The EFA in sample I suggested a two-component solution: a subscale 'perception of delivery' (six items) and a subscale 'perception of the first postpartum week' (six items). The CFA in sample II confirmed an adequate model fit and a good internal consistency (α=.82). Multivariate linear regression showed a positive effect of home delivery on perception of delivery in multiparous but not in primiparous women. The 12-item CPS with two dimensions (perception of delivery and perception of first postpartum week) has adequate psychometric properties. In multiparous women, home delivery showed to be independently related to more positive perception of delivery.

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Too early to question effectiveness of Dutch system

Cited by 14 publications

References 4 publications

Intrapartum and neonatal mortality in low‐risk term women in midwife‐led care and obstetrician‐led care at the onset of labor: A national matched cohort study

Intrapartum and neonatal mortality in low‐risk term women in midwife‐led care and obstetrician‐led care at the onset of labor: A national matched cohort study

Perinatal mortality and morbidity up to 28 days after birth among 743 070 low-risk planned home and hospital births: a cohort study based on three merged national perinatal databases

Development of the Childbirth Perception Scale (CPS): perception of delivery and the first postpartum week

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