M M J Wiegerinck1, B Y van der Goes2, A C J Ravelli3, J A M van der Post4, J Klinkert5, J Brandenbarg6, F C D Buist7, M G A J Wouters8, P Tamminga9, A de Jonge10, B W Mol11. 1. Academic Medical Center, Department of Obstetrics and Gynaecology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: m.m.wiegerinck@amc.uva.nl. 2. Academic Medical Center, Department of Obstetrics and Gynaecology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: b.y.vandergoes@amc.uva.nl. 3. Academic Medical Center, Department of Medical Informatics, 1100 DE Amsterdam, The Netherlands; Academic Medical Center, Department of Obstetrics, PO Box 22700, 1100 DE Amsterdam, The Netherlands. Electronic address: a.c.ravelli@amc.uva.nl. 4. Academic Medical Center, Department of Obstetrics and Gynaecology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: j.a.vanderpost@amc.uva.nl. 5. Midwives in Primary care Amsterdam and Amstelland (EVAA), Rijtuigenhof 105, 1054 NC Amsterdam, The Netherlands. Electronic address: jokeklinkert@gmail.com. 6. Practice for Obstetrics, Dietetics and Coaching, Margaretha van Borsselenlaan 39, 1181 CZ, Amstelveen, The Netherlands. Electronic address: jokebrandenbarg@xs4all.nl. 7. VU University Medical Center, Department of Obstetrics and Gynaecology, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. Electronic address: fcd.buist@vumc.nl. 8. VU University Medical Center, Department of Obstetrics and Gynaecology, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. Electronic address: mgaj.wouters@vumc.nl. 9. Emma Children's Hospital AMC, Neonatal Intensive Care, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: p.tamminga@amc.uva.nl. 10. AVAG/ EMGO+, VU University Medical Center, Department of Midwifery Science, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. Electronic address: ank.dejonge@vumc.nl. 11. The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, K William Street 72, 5000SA Adelaide, Australia. Electronic address: b.w.mol@amc.uva.nl.
Abstract
OBJECTIVE: To compare intrapartum- and neonatal mortality and intervention rates in term women starting labour in primary midwife-led versus secondary obstetrician-led care. DESIGN: Retrospective cohort study. SETTING: Amsterdam region of the Netherlands. PARTICIPANTS: Women with singleton pregnancies who gave birth beyond 37+0 weeks gestation in the years 2005 up to 2008 and lived in the catchment area of the neonatal intensive care units of both academic hospitals in Amsterdam. Women with a primary caesarean section or a pregnancy complicated by antepartum death or major congenital anomalies were excluded. For women in the midwife-led care group, a home or hospital birth could be planned. MEASUREMENTS: Analysis of linked data from the national perinatal register, and hospital- and midwifery record data. We assessed (unadjusted) relative risks with confidence intervals. Main outcome measures were incidences of intrapartum and neonatal (<28 days) mortality. Secondary outcomes included incidences of caesarean section and vaginal instrumental delivery. FINDINGS: 53,123 women started labour in primary care and 30,166 women in secondary care. Intrapartum and neonatal mortality rates were 37/53,123 (0.70‰) in the primary care group and 24/30,166 (0.80‰) in the secondary care group (relative risk 0.88; 95% CI 0.52-1.46). Women in the primary care group were less likely to deliver by secondary caesarean section (5% versus 16%; RR 0.31; 95% CI 0.30-0.32) or by instrumental delivery (10% versus 13%; RR 0.76; 95% CI 0.73-0.79). KEY CONCLUSIONS: We found a low absolute risk of intrapartum and neonatal mortality, with a comparable risk for women who started labour in primary versus secondary care. The intervention rate was significantly lower in women who started labour in primary care. IMPLICATIONS FOR PRACTICE: These findings suggest that it is possible to identify a group of women at low risk of complications that can start labour in primary care and have low rates of medical interventions whereas perinatal mortality is low.
OBJECTIVE: To compare intrapartum- and neonatal mortality and intervention rates in term women starting labour in primary midwife-led versus secondary obstetrician-led care. DESIGN: Retrospective cohort study. SETTING: Amsterdam region of the Netherlands. PARTICIPANTS: Women with singleton pregnancies who gave birth beyond 37+0 weeks gestation in the years 2005 up to 2008 and lived in the catchment area of the neonatal intensive care units of both academic hospitals in Amsterdam. Women with a primary caesarean section or a pregnancy complicated by antepartum death or major congenital anomalies were excluded. For women in the midwife-led care group, a home or hospital birth could be planned. MEASUREMENTS: Analysis of linked data from the national perinatal register, and hospital- and midwifery record data. We assessed (unadjusted) relative risks with confidence intervals. Main outcome measures were incidences of intrapartum and neonatal (<28 days) mortality. Secondary outcomes included incidences of caesarean section and vaginal instrumental delivery. FINDINGS: 53,123 women started labour in primary care and 30,166 women in secondary care. Intrapartum and neonatal mortality rates were 37/53,123 (0.70‰) in the primary care group and 24/30,166 (0.80‰) in the secondary care group (relative risk 0.88; 95% CI 0.52-1.46). Women in the primary care group were less likely to deliver by secondary caesarean section (5% versus 16%; RR 0.31; 95% CI 0.30-0.32) or by instrumental delivery (10% versus 13%; RR 0.76; 95% CI 0.73-0.79). KEY CONCLUSIONS: We found a low absolute risk of intrapartum and neonatal mortality, with a comparable risk for women who started labour in primary versus secondary care. The intervention rate was significantly lower in women who started labour in primary care. IMPLICATIONS FOR PRACTICE: These findings suggest that it is possible to identify a group of women at low risk of complications that can start labour in primary care and have low rates of medical interventions whereas perinatal mortality is low.
Authors: Melanie M J Wiegerinck; Birgit Y van der Goes; Anita C J Ravelli; Joris A M van der Post; Fayette C D Buist; Pieter Tamminga; Ben W Mol Journal: BMJ Open Date: 2018-01-05 Impact factor: 2.692
Authors: Jacoba van der Kooy; Erwin Birnie; Semiha Denktas; Eric A P Steegers; Gouke J Bonsel Journal: BMC Pregnancy Childbirth Date: 2017-06-08 Impact factor: 3.007