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Gravesteijn BY, Boderie NW, van den Akker T, Bertens LCM, Bloemenkamp K, Burgos Ochoa L, de Jonge A, Kazemier BM, Klein PPF, Kwint-Reijnders I, Labrecque JA, Mol BW, Obermann-Borst SA, Peters L, Ravelli ACJ, Rosman A, Been JV, de Groot CJ. Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands: a national quasi-experimental study. Public Health 2024; 235:15-25. [PMID: 39033718 DOI: 10.1016/j.puhe.2024.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/29/2024] [Accepted: 06/17/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVES The COVID-19 pandemic and associated lockdowns disrupted health care worldwide. High-income countries observed a decrease in preterm births during lockdowns, but maternal pregnancy-related outcomes were also likely affected. This study investigates the effect of the first COVID-19 lockdown (March-June 2020) on provision of maternity care and maternal pregnancy-related outcomes in the Netherlands. STUDY DESIGN National quasi-experimental study. METHODS Multiple linked national registries were used, and all births from a gestational age of 24+0 weeks in 2010-2020 were included. In births starting in midwife-led primary care, we assessed the effect of lockdown on provision of care. In the general pregnant population, the impact on characteristics of labour and maternal morbidity was assessed. A difference-in-regression-discontinuity design was used to derive causal estimates for the year 2020. RESULTS A total of 1,039,728 births were included. During the lockdown, births to women who started labour in midwife-led primary care (49%) more often ended at home (27% pre-lockdown, +10% [95% confidence interval: +7%, +13%]). A small decrease was seen in referrals towards obstetrician-led care during labour (46%, -3% [-5%,-0%]). In the overall group, no significant change was seen in induction of labour (27%, +1% [-1%, +3%]). We found no significant changes in the incidence of emergency caesarean section (9%, -1% [-2%, +0%]), obstetric anal sphincter injury (2%, +0% [-0%, +1%]), episiotomy (21%, -0% [-2%, +1%]), or post-partum haemorrhage: >1000 ml (6%, -0% [-1%, +1%]). CONCLUSIONS During the first COVID-19 lockdown in the Netherlands, a substantial increase in homebirths was seen. There was no evidence for changed available maternal outcomes, suggesting that a maternity care system with a strong midwife-led primary care system may flexibly and safely adapt to external disruptions.
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Affiliation(s)
- B Y Gravesteijn
- Department of Obstetrics & Gynaecology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam Reproduction & Development, Amsterdam, the Netherlands; Department of Public Health, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - N W Boderie
- Department of Public Health, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - T van den Akker
- Department of Obstetrics & Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands; Athena Institute, VU University, Amsterdam, the Netherlands; Department of Public Health, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - L C M Bertens
- Department of Obstetrics & Gynaecology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - K Bloemenkamp
- Department of Obstetrics, WKZ Birth Centre, Division Woman and Baby, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L Burgos Ochoa
- Department of Obstetrics & Gynaecology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Methodology and Statistics, Tilburg University, Tilburg, the Netherlands
| | - A de Jonge
- Department of Midwifery Science, Amsterdam University Medical Center, Amsterdam, the Netherlands; Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands; Department of Primary Care and Long-Term Care, University Medical Center Groningen, Groningen, the Netherlands
| | - B M Kazemier
- Department of Obstetrics & Gynaecology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam Reproduction & Development, Amsterdam, the Netherlands; Department of Obstetrics, WKZ Birth Centre, Division Woman and Baby, University Medical Center Utrecht, Utrecht, the Netherlands
| | - P P F Klein
- Department of Health Economics and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - I Kwint-Reijnders
- Department of Obstetrics & Gynaecology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands; Care4Neo, Neonatal Patient and Parent Advocacy Organization, Rotterdam, the Netherlands
| | - J A Labrecque
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - B W Mol
- Department of Obstetrics & Gynaecology, Monash University, Melbourne, Australia
| | - S A Obermann-Borst
- Care4Neo, Neonatal Patient and Parent Advocacy Organization, Rotterdam, the Netherlands
| | - L Peters
- Department of Midwifery Science, Amsterdam University Medical Center, Amsterdam, the Netherlands; Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, the Netherlands; Department of Primary Care and Long-Term Care, University Medical Center Groningen, Groningen, the Netherlands
| | - A C J Ravelli
- Department of Obstetrics & Gynaecology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam Reproduction & Development, Amsterdam, the Netherlands; Department of Medical Informatics, Amsterdam Public Health, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - A Rosman
- Perined, Utrecht, the Netherlands
| | - J V Been
- Department of Public Health, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Obstetrics & Gynaecology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands; Division of Neonatology, Department of Neonatal and Paediatric Intensive Care, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - C J de Groot
- Department of Obstetrics & Gynaecology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam Reproduction & Development, Amsterdam, the Netherlands
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Moulds ML, Bisby MA, Black MJ, Jones K, Harrison V, Hirsch CR, Newby JM. Repetitive negative thinking in the perinatal period and its relationship with anxiety and depression. J Affect Disord 2022; 311:446-462. [PMID: 35597469 DOI: 10.1016/j.jad.2022.05.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/04/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Rumination and worry represent two types of repetitive negative thinking (RNT), and their predictive and maintaining roles are well-established in depression and anxiety, respectively. Furthermore, there is an emerging literature on the link between RNT and psychological wellbeing in the perinatal period. METHODS We conducted a scoping review of studies that have investigated the relationship between RNT and perinatal depression and anxiety. We identified 87 papers eligible for inclusion in the review; they included cross-sectional and longitudinal studies, as well as treatment evaluations (pilot trials and randomised controlled trials). RESULTS Cross-sectional studies provided evidence of an association between RNT (i.e., rumination and worry) and depression and anxiety, in both pregnancy and postpartum. Longitudinal findings were mixed. Whilst antenatal worry consistently predicted subsequent depression and anxiety (both later in pregnancy and postpartum), rumination did not consistently predict depression. However, there was some evidence that rumination interacted with other processes to predict later psychopathology. Three randomised controlled trials evaluated whether psychological treatments reduce RNT in the perinatal period, only one of which included a clinical sample. LIMITATIONS No experimental investigations were eligible for inclusion in the review. CONCLUSIONS Further studies are needed to further our understanding of the nature and role of RNT in pregnancy and postpartum, and its consequences for maternal mental health. These include (but are not limited to) experimental investigations, studies with large clinical samples, and RCTs evaluating the effectiveness of psychological interventions targeting RNT to prevent and treat perinatal depression and anxiety.
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Affiliation(s)
| | - Madelyne A Bisby
- eCentreClinic, School of Psychological Sciences, Macquarie University, Australia
| | - Melissa J Black
- School of Psychology, UNSW Sydney, Australia; Black Dog Institute, UNSW Sydney, Australia
| | - Katie Jones
- School of Health, Wellbeing and Social Care, The Open University, UK
| | | | - Colette R Hirsch
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; South London and Maudsley NHS Foundation Trust, UK
| | - Jill M Newby
- School of Psychology, UNSW Sydney, Australia; Black Dog Institute, UNSW Sydney, Australia
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Verhoeven CJM, Boer J, Kok M, Nieuwenhuijze M, de Jonge A, Peters LL. More home births during the COVID-19 pandemic in the Netherlands. Birth 2022; 49:792-804. [PMID: 35554962 PMCID: PMC9348372 DOI: 10.1111/birt.12646] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND The aim of this observational study was to examine whether the course of pregnancy and birth and accompanying outcomes among low-risk pregnant women changed in the COVID-19 pandemic compared to the prepandemic period. METHODS We analyzed data from the Dutch Midwifery Case Registration System (VeCaS). Differences in the course of pregnancy and birth, and accompanying maternal and neonatal outcomes, were calculated between women pregnant during the initial months of the COVID-19 pandemic (March 1 to August 3, 2020) and the prepandemic period (March 1-August 3, 2019). We also conducted a stratified analysis by parity. RESULTS We included 5913 low-risk pregnant women of whom 2963 (50.1%) were pregnant during the first surge of the COVID-19 pandemic, and 2950 (49.9%) in the prepandemic period. During the COVID-19 pandemic, more women desired and had a home birth. More women used pain medication and fewer had an episiotomy in the COVID-19 period than prior. Multiparous women had a higher suspected rate of fetal growth restriction during COVID; however, the actual rate of small for gestational age infants was not significantly increased. We observed no differences for onset and augmentation of labor or for mode of birth, though the rate of vaginal births increased. CONCLUSIONS During the COVID-19 pandemic, there was a higher rate of planned and actual home birth, and suspected growth restriction and a lower rate of episiotomy among low-risk pregnant women in the Netherlands.
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Affiliation(s)
- Corine J. M. Verhoeven
- Department of Midwifery Science, AVAG/Amsterdam Reproduction and Development CenterAmsterdam University Medical Centres, Vrije Universiteit AmsterdamAmsterdamNetherlands,Department of Midwifery, School of Health SciencesUniversity of NottinghamNottinghamUK,Department of Obstetrics and GynaecologyMaxima Medical CentreVeldhoventhe Netherlands
| | - José Boer
- Department of Midwifery Science, AVAG/Amsterdam Reproduction and Development CenterAmsterdam University Medical Centres, Vrije Universiteit AmsterdamAmsterdamNetherlands
| | - Marjolein Kok
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development CenterAmsterdam University Medical Centre, Universiteit van AmsterdamAmsterdamthe Netherlands
| | - Marianne Nieuwenhuijze
- Research Centre for Midwifery ScienceZuyd UniversityMaastrichtthe Netherlands,CAPHRI School for Public Health and Primary CareMaastricht UniversityMaastrichtthe Netherlands
| | - Ank de Jonge
- Department of Midwifery Science, AVAG/Amsterdam Public Health Research InstituteAmsterdam University Medical Centres, Vrije Universiteit AmsterdamAmsterdamNetherlands
| | - Lilian L. Peters
- Department of Midwifery Science, AVAG/Amsterdam Reproduction and Development CenterAmsterdam University Medical Centres, Vrije Universiteit AmsterdamAmsterdamNetherlands,Department of General Practice and Elderly Care MedicineUniversity of Groningen, University Medical Centre GroningenGroningenthe Netherlands
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Planned Place of Birth-Impact of Psychopathological Risk Factors on the Choice of Birthplace and Its Postpartum Effect on Psychological Adaption: An Exploratory Study. J Clin Med 2022; 11:jcm11020292. [PMID: 35053986 PMCID: PMC8779342 DOI: 10.3390/jcm11020292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 02/05/2023] Open
Abstract
The choice of birthplace may have an important impact on a woman’s health. In this longitudinal study, we investigated the psychopathological risk factors that drive women’s choice of birthplace, since their influence is currently not well understood. The research was conducted in 2011/12 and we analyzed data of 177 women (obstetric unit, n = 121; free standing midwifery unit, n = 42; homebirth, n = 14). We focused antepartally (M = 34.3 ± 3.3) on sociodemographic and risk factors of psychopathology, such as prenatal distress (Prenatal Distress Questionnaire), depressiveness (Edinburgh Postnatal Depression Scale), birth anxiety (Birth Anxiety Scale), childhood trauma (Childhood Trauma Questionnaire), and postpartally (M = 6.65 ± 2.6) on birth experience (Salmon’s Item List), as well as psychological adaption, such as postpartum depressive symptoms (Edinburgh Postnatal Depression Scale) and birth anxiety felt during birth (modified Birth Anxiety Scale). Women with fear of childbirth and the beginning of birth were likely to plan a hospital birth. In contrast, women with fear of touching and palpation by doctors and midwives, as well as women with childhood trauma, were more likely to plan an out-of-hospital birth. Furthermore, women with planned out-of-hospital births experienced a greater relief of their birth anxiety during the birth process than women with planned hospital birth. Our results especially show that women with previous mental illnesses, as well as traumatic experiences, seem to have special needs during childbirth, such as a safe environment and supportive care.
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Martos T, Sallay V, Rafael B, Konkolÿ Thege B. Preferred ways of giving birth in non-pregnant and pregnant nulliparous women: the role of control beliefs. J Psychosom Obstet Gynaecol 2021; 42:201-211. [PMID: 31928281 DOI: 10.1080/0167482x.2019.1710486] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To explore the association between delivery-specific, health-related control beliefs and preferred ways of delivery in nulliparous Hungarian women. Moreover, since data about the delivery-specific control beliefs and delivery-related preferences of non-pregnant nulliparous women are lacking, the present study also seeks to provide descriptive information in this regard. METHODS A total of 984 Hungarian nulliparous women (26.45 ± 5.42 years; 660/77.2% non-pregnant and 224/22.8% pregnant) were included in the present study. The online assessment included measures of delivery-specific (internal-, healthcare professional-, and chance-related) health control beliefs, fears of childbirth, self-esteem, as well as preferences regarding delivery setting (i.e. spontaneous vaginal birth in hospital, planned cesarean birth and home birth). RESULTS Healthcare professional-related control beliefs were associated with a stronger preference for spontaneous vaginal birth in hospital (OR = 1.87, 95% CI: 1.56-2.23) and planned cesarean birth (OR = 1.96, 95% CI: 1.60-2.40), alongside a weaker preference for home birth (OR = 0.31, 95% CI: 0.25-0.39). In contrast, internal delivery-specific control beliefs predicted a weaker preference for planned cesarean (OR = 0.66, 95% CI: 0.55-0.78) and a stronger preference for home birth (OR = 1.63, 95% CI: 1.33-2.00). A general preference index for medicalized ways of delivery was negatively associated with internal - and positively with healthcare professional - and chance-related control beliefs (βs = -.173, .074 and .445, respectively). CONCLUSIONS Delivery-related control beliefs are important psychological characteristics in the prediction of preferences for ways of delivery. Understanding delivery-specific control beliefs may be an important component of supporting women to give birth in a mentally and physically healthy way.
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Affiliation(s)
- Tamás Martos
- Institute of Psychology, University of Szeged, Szeged, Hungary
| | - Viola Sallay
- Institute of Psychology, University of Szeged, Szeged, Hungary
| | - Beatrix Rafael
- Institute of Psychology, University of Szeged, Szeged, Hungary.,Department of Medical Rehabilitation and Physical Medicine, University of Szeged, Szeged, Hungary
| | - Barna Konkolÿ Thege
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Pouwels A, Offerhaus P, Merkx A, Zeegers B, Nieuwenhuijze MJ. Detailed registration of care in midwifery practices in the Netherlands: an opportunity for research within a healthy pregnant population. BMC Pregnancy Childbirth 2020; 20:366. [PMID: 32546154 PMCID: PMC7296943 DOI: 10.1186/s12884-020-03053-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background Research in maternity care is often conducted in mixed low and high-risk or solely high-risk populations. This limits generalizability to the low-risk population of pregnant women receiving care from Dutch midwives. To address this limitation, 24 midwifery practices in the Netherlands bring together routinely collected data from medical records of pregnant women and their offspring in the VeCaS database. This database offers possibilities for research of physiological pregnancy and childbirth. This study explores if the pregnant women in VeCaS are a representative sample for the national population of women who receive primary midwife-led care in the Netherlands. Methods In VeCaS we selected a low risk population in midwife-led care who gave birth in 2015. We compared population characteristics and birth outcomes in this study cohort with a similarly defined national cohort, using Chi Square and two side t-test statistics. Additionally, we describe some birth outcomes and lifestyle factors. Results Midwifery practices contributing to VeCaS are spread over the Netherlands, although the western region is underrepresented. For population characteristics, the VeCaS cohort is similar to the national cohort in maternal age (mean 30.4 years) and parity (nulliparous women: 47.1% versus 45.9%). Less often, women in the VeCaS cohort have a non-Dutch background (15.7% vs 24.4%), a higher SES (9.9% vs 23.7%) and live in an urbanised surrounding (4.9% vs 24.8%). Birth outcomes were similar to the national cohort, most women gave birth at term (94.9% vs 94.5% between 37 + 0–41+ 6 weeks), started labour spontaneously (74.5% vs 75.5%) and had a spontaneous vaginal birth (77.4% vs 77.6%), 16.9% had a home birth. Furthermore, 61.1% had a normal pre-pregnancy BMI, and 81.0% did not smoke in pregnancy. Conclusions The VeCaS database contains data of a population that is mostly comparable to the national population in primary midwife-led care in the Netherlands. Therefore, the VeCaS database is suitable for research in a healthy pregnant population and is valuable to improve knowledge of the physiological course of pregnancy and birth. Representativeness of maternal characteristics may be improved by including midwifery practices from the urbanised western region in the Netherlands.
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Affiliation(s)
- A Pouwels
- Research Centre for Midwifery Science, Zuyd University, Maastricht, the Netherlands.
| | - P Offerhaus
- Research Centre for Midwifery Science, Zuyd University, Maastricht, the Netherlands
| | - A Merkx
- Research Centre for Midwifery Science, Zuyd University, Maastricht, the Netherlands
| | - B Zeegers
- Research Centre for Midwifery Science, Zuyd University, Maastricht, the Netherlands
| | - M J Nieuwenhuijze
- Research Centre for Midwifery Science, Zuyd University, Maastricht, the Netherlands
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7
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Sluijs A, Cleiren MP, van Lith JM, Wijma B, Wijma K. Is fear of childbirth related to the woman's preferred location for giving birth? A Dutch low-risk cohort study. Birth 2020; 47:144-152. [PMID: 31549440 PMCID: PMC7065170 DOI: 10.1111/birt.12456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/09/2019] [Accepted: 09/09/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND In The Netherlands, women with low-risk pregnancy are routinely given the option of home birth, providing a unique opportunity to study the relationship between fear of childbirth (FOC) and preference for childbirth location, and whether women experience higher FOC when the actual location differs from their preference. METHODS In this prospective cohort study, 331 nulliparous and parous women completed a questionnaire at gestational week 30 (T1) and two months postpartum (T2). FOC was assessed using versions A (T1) and B (T2) of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). RESULTS At T1, women who preferred home birth had significantly lower FOC compared with women who preferred a hospital birth (mean ± SD W-DEQ scores: 55 ± 19.8 and 64 ± 18.3, respectively, P < .01). About 28% of women who responded at T2 gave birth at home. Congruence between the preferred and actual childbirth location was not predictive of FOC assessed at T2 when adjusted for obstetric and psychological variables. In an extended analysis, we found that except for prepartum FOC, the following variables also correlated with postpartum FOC: being referred because of complications and poor neonatal condition. CONCLUSIONS Compared to women who prefer hospital birth, women who prefer home birth have lower prepartum and postpartum FOC. Giving birth at a location other than the preferred location does not appear to affect postpartum FOC. Whether giving birth at home or in the hospital, caregivers should pay extra attention to women with high FOC because they are vulnerable to postpartum FOC, especially after a complicated birth and referral.
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Affiliation(s)
- Anne‐Marie Sluijs
- Department of ObstetricsLeiden University Medical CenterLeidenThe Netherlands
| | - Marc P.H.D. Cleiren
- Faculty of Social SciencesHonours CollegeLeiden UniversityLeidenThe Netherlands
| | - Jan M.M. van Lith
- Department of ObstetricsLeiden University Medical CenterLeidenThe Netherlands
| | - Barbro Wijma
- Unit of Gender and MedicineDepartment of Clinical and Experimental MedicineLinköping UniversityLinköpingSweden
| | - Klaas Wijma
- Unit of Medical PsychologyDepartment of Clinical and Experimental MedicineLinköping UniversityLinköpingSweden
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Fletcher BR, Rowe R, Hollowell J, Scanlon M, Hinton L, Rivero-Arias O. Exploring women's preferences for birth settings in England: A discrete choice experiment. PLoS One 2019; 14:e0215098. [PMID: 30973919 PMCID: PMC6459528 DOI: 10.1371/journal.pone.0215098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/26/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To explore pregnant women's preferences for birth setting in England. DESIGN Labelled discrete choice experiment (DCE). SETTING Online survey. SAMPLE Pregnant women recruited through social media and an online panel. METHODS We developed a DCE to assess women's preferences for four hypothetical birth settings based on seven attributes: reputation, continuity of care, distance from home, time to see a doctor, partner able to stay overnight, chance of straightforward birth and safety for baby. We used a mixed logit model, with setting modelled as an alternative-specific constant, and conducted a scenario analysis to evaluate the impact of changes in attribute levels on uptake of birth settings. MAIN OUTCOME MEASURES Women's preferences for birth setting. RESULTS 257 pregnant women completed the DCE. All birth setting attributes, except 'time to see doctor', were significant in women's choice (p<0.05). There was significant heterogeneity in preferences for some attributes. Changes to levels for 'safety for the baby' and 'partner able to stay overnight' were associated with larger changes from baseline uptake of birth setting. If the preferences identified were translated into the real-world context up to a third of those who reported planning birth in an obstetric unit might choose a midwifery unit assuming universal access to all settings, and knowledge of the differences between settings. CONCLUSIONS We found that 'safety for the baby', 'chance of a straightforward birth' and 'can the woman's partner stay overnight following birth' were particularly important in women's preferences for hypothetical birth setting. If all birth settings were available to women and they were aware of the differences between them, it is likely that more low risk women who currently plan birth in OUs might choose a midwifery unit.
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Affiliation(s)
- Benjamin Rupert Fletcher
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rachel Rowe
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jennifer Hollowell
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | | | - Lisa Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Oliver Rivero-Arias
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Olza I, Leahy-Warren P, Benyamini Y, Kazmierczak M, Karlsdottir SI, Spyridou A, Crespo-Mirasol E, Takács L, Hall PJ, Murphy M, Jonsdottir SS, Downe S, Nieuwenhuijze MJ. Women's psychological experiences of physiological childbirth: a meta-synthesis. BMJ Open 2018; 8:e020347. [PMID: 30341110 PMCID: PMC6196808 DOI: 10.1136/bmjopen-2017-020347] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To synthesise qualitative studies on women's psychological experiences of physiological childbirth. DESIGN Meta-synthesis. METHODS Studies exploring women's psychological experiences of physiological birth using qualitative methods were eligible. The research group searched the following databases: MEDLINE, CINAHL, PsycINFO, PsycARTICLES, SocINDEX and Psychology and Behavioural Sciences Collection. We contacted the key authors searched reference lists of the collected articles. Quality assessment was done independently using the Critical Appraisal Skills Programme (CASP) checklist. Studies were synthesised using techniques of meta-ethnography. RESULTS Eight studies involving 94 women were included. Three third order interpretations were identified: 'maintaining self-confidence in early labour', 'withdrawing within as labour intensifies' and 'the uniqueness of the birth experience'. Using the first, second and third order interpretations, a line of argument developed that demonstrated 'the empowering journey of giving birth' encompassing the various emotions, thoughts and behaviours that women experience during birth. CONCLUSION Giving birth physiologically is an intense and transformative psychological experience that generates a sense of empowerment. The benefits of this process can be maximised through physical, emotional and social support for women, enhancing their belief in their ability to birth and not disturbing physiology unless it is necessary. Healthcare professionals need to take cognisance of the empowering effects of the psychological experience of physiological childbirth. Further research to validate the results from this study is necessary. PROSPERO REGISTRATION NUMBER CRD42016037072.
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Affiliation(s)
- Ibone Olza
- Faculty of Medicine, Universidad de Alcala de Henares, Alcala de Henares, Madrid, Spain
| | | | - Yael Benyamini
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Andria Spyridou
- Department of Psychology, Universitat Konstanz Fachbereich Psychologie, Konstanz, Baden-Württemberg, Germany
| | | | - Lea Takács
- Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic
| | - Priscilla J Hall
- Emory University. Nell Hodgson Woodruff School of Nursing, Atlanta, USA
| | - Margaret Murphy
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | | | - Soo Downe
- University of Central Lancashire, preston, Lancashire, UK
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Handelzalts JE, Preis H, Rosenbaum M, Gozlan M, Benyamini Y. PREGNANT WOMEN'S RECOLLECTIONS OF EARLY MATERNAL BONDING: ASSOCIATIONS WITH MATERNAL-FETAL ATTACHMENT AND BIRTH CHOICES. Infant Ment Health J 2018; 39:511-521. [PMID: 30080937 DOI: 10.1002/imhj.21731] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Recollections of own maternal care measured by parental bonding were found to be important in the pregnant woman's construction of herself as a mother. Although these recollections were studied with regard to various variables, there is a dearth of studies associated with pregnancy and childbirth. In this cross-sectional study, 341 pregnant women were recruited. Measures included a Sociodemographics-Obstetric History Questionnaire; the Childbirth Choices Questionnaire (H. Preis, M. Gozlan, U. Dan, & Y. Benyamini, 2018); the Parental Bonding Instrument (G. Parker, H. Tupling, & L.B. Brown, 1979); a question regarding the planned presence of the woman's mother at delivery; and the Maternal-Fetal Attachment Scale (M.S. Cranley, 1981). Parental recollections of Care were associated with fewer natural birth choices (hence, a more "medicalized" delivery), lower maternal-fetal attachment, and a wish for the mother's mother to be present at the birth. Parental recollections of Encouragement of Behavioral Freedom in childhood were associated with more natural choices regarding childbirth. In addition, women with higher scores on the parental bonding Denial of Autonomy factor reported stronger maternal-fetal attachment. Thus, early recollections of experiences with caregivers as manifested in parental bonding may be a possible influence on the transition to motherhood, and working through possible difficulties associated with these recollections may improve adjustment to motherhood.
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Affiliation(s)
- Jonathan E Handelzalts
- The Academic College of Tel-Aviv Yaffo, Tel-Aviv, 68114, Israel; School of Behavioral Sciences
| | - Heidi Preis
- Tel Aviv University, Tel Aviv 6997801, Israel; Bob Shapell School of Social Work
| | - Maya Rosenbaum
- Tel Aviv University, Tel Aviv 6997801, Israel; Bob Shapell School of Social Work
| | - Miri Gozlan
- Maccabi Health Services, 1 Lishansky St., Rishon Le'zion, Israel; Women's Health Center
| | - Yael Benyamini
- Tel Aviv University, Tel Aviv 6997801, Israel; Bob Shapell School of Social Work
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Cal M, Meira A, Clode N. Ability of women to self-classify into the Robson ten-group classification system. Int J Gynaecol Obstet 2018; 143:195-198. [PMID: 29957875 DOI: 10.1002/ijgo.12577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/15/2018] [Accepted: 06/27/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Recent guidelines from WHO and the International Federation of Gynecology and Obstetrics (FIGO) state that the Robson ten-group classification system (TGCS) should be universally applied to pregnant women. Such information might enable women to make an informed decision about the place and mode of delivery. We assessed whether women could self-classify correctly according to the TGCS. METHODS A prospective study was conducted in a tertiary level maternity hospital between March 6 and July 31, 2017. We included post-partum women admitted to the puerperium ward. Participants were instructed to complete a multiple-choice questionnaire with a simplified description of TGCS and to classify themselves into one of the ten groups. A practitioner reclassified women into the correct TGCS group. Cohen κ was applied to measure the rate of agreement between these two evaluations. RESULTS 400 women were enrolled, with a global rate of agreement of 81.8% between women's self-evaluation and the evaluation by the practitioner. A subanalysis showed that the highest rate of agreement was among the group with higher level education (84.0%). CONCLUSION Women of different ages and education backgrounds were able to correctly classify themselves into the TGCS. The higher the educational level, the greater the rate of agreement.
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Affiliation(s)
- Margarida Cal
- Department of Obstetrics and Gynecology, Centro Hospitalar Lisboa Norte-Hospital de Santa Maria, Lisbon, Portugal
| | - Alexandra Meira
- Department of Obstetrics and Gynecology, Centro Hospitalar Lisboa Norte-Hospital de Santa Maria, Lisbon, Portugal
| | - Nuno Clode
- Department of Obstetrics and Gynecology, Centro Hospitalar Lisboa Norte-Hospital de Santa Maria, Lisbon, Portugal
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Women's Preferences for Birthing Hospital in Denmark: A Discrete Choice Experiment. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 11:613-624. [PMID: 29766464 DOI: 10.1007/s40271-018-0313-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Free choice of hospital has been introduced in many healthcare systems to accommodate patient preferences and incentivize hospitals to compete; however, little is known about what patients actually prefer. OBJECTIVES This study assessed women's preferences for birthing hospital in Denmark by quantifying the utility and trade-offs of hospital attributes. METHODS We conducted a discrete-choice experiment survey with 12 hypothetical scenarios in which women had to choose between three hospitals characterized by five attributes: continuity of midwifery care, availability of a neonatal intensive care unit (NICU), hospital services offered, level of specialization to handle rare events, and travel time. A random parameter logit model was used to estimate the utility and marginal willingness to travel (WTT) for improvements in other hospital attributes. RESULTS A total of 517 women completed the survey. Significant preferences were expressed for all attributes (p < 0.01), with the availability of a NICU being the most important driver of women's preferences; women were willing to travel 30 more minutes (95% confidence interval 28-32) to reach a hospital with a highly specialized NICU. The subgroup analyses revealed differences in WTT, with substantial heterogeneity due to prior experience with giving birth and regarding risk attitude and health literacy. CONCLUSION A high specialization level was the most influential factor for women without previous birth experience and for risk-averse individuals but not for women with a high health literacy score. Hence, more information about the woman's risk profile and services required could play a role in affecting hospital choice.
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Hitzert M, Hermus MMAA, Boesveld IIC, Franx A, van der Pal-de Bruin KKM, Steegers EEAP, van den Akker-van Marle EIME. Cost-effectiveness of planned birth in a birth centre compared with alternative planned places of birth: results of the Dutch Birth Centre study. BMJ Open 2017; 7:e016960. [PMID: 28893750 PMCID: PMC5595203 DOI: 10.1136/bmjopen-2017-016960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To estimate the cost-effectiveness of a planned birth in a birth centre compared with alternative planned places of birth for low-risk women. In addition, a distinction has been made between different types of locations and integration profiles of birth centres. DESIGN Economic evaluation based on a prospective cohort study. SETTING 21 Dutch birth centres, 46 hospital locations where midwife-led birth was possible and 110 midwifery practices where home birth was possible. PARTICIPANTS 3455 low-risk women under the care of a community midwife at the start of labour in the Netherlands within the study period 1 July 2013 to 31 December 2013. MAIN OUTCOME MEASURES Costs and health outcomes of birth for different planned places of birth. Healthcare costs were measured from start of labour until 7 days after birth. The health outcomes were assessed by the Optimality Index-NL2015 (OI) and a composite adverse outcomes score. RESULTS The total adjusted mean costs for births planned in a birth centre, in a hospital and at home under the care of a community midwife were €3327, €3330 and €2998, respectively. There was no difference between the score on the OI for women who planned to give birth in a birth centre and that of women who planned to give birth in a hospital. Women who planned to give birth at home had better outcomes on the OI (higher score on the OI). CONCLUSIONS We found no differences in costs and health outcomes for low-risk women under the care of a community midwife with a planned birth in a birth centre and in a hospital. For nulliparous and multiparous low-risk women, planned birth at home was the most cost-effective option compared with planned birth in a birth centre.
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Affiliation(s)
- Marit Hitzert
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | | | - Arie Franx
- Department of Division Woman and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Eric, EAP Steegers
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Satisfaction with caregivers during labour among low risk women in the Netherlands: the association with planned place of birth and transfer of care during labour. BMC Pregnancy Childbirth 2017; 17:229. [PMID: 28705146 PMCID: PMC5513372 DOI: 10.1186/s12884-017-1410-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/05/2017] [Indexed: 11/23/2022] Open
Abstract
Background The caregiver has an important influence on women’s birth experiences. When transfer of care during labour is necessary, care is handed over from one caregiver to the other, and this might influence satisfaction with care. It is speculated that satisfaction with care is affected in particular for women who need to be transferred from home to hospital. We examined the level of satisfaction with the caregiver among women with planned home versus planned hospital birth in midwife-led care. Methods We used data from the prospective multicentre DELIVER (Data EersteLIjns VERloskunde) cohort-study, conducted in 2009 and 2010 in the Netherlands. Women filled in a postpartum questionnaire which contained elements of the Consumer Quality index. This instrument measures 'general rate of satisfaction with the caregiver’ (scale from 1 to 10, with cut-off of below 9) and ‘quality of treatment by the caregiver’ (containing 7 items on a 4 point Likert scale, with cut-off of mean of 4 or lower). Results Women who planned a home birth (n = 1372) significantly more often rated 'quality of treatment by caregiver' high than women who planned a hospital birth (n = 829). Primiparous women who planned a home birth significantly more often had a high rate (9 or 10) for ‘general satisfaction with caregiver’ (adj.OR 1.48; 95% CI 1.1, 2.0). Also, primiparous women who planned a home birth and had care transferred during labour (331/553; 60%) significantly more often had a high rate (9 or 10) for ‘general satisfaction’ compared to those who planned a hospital birth and who had care transferred (1.44; 1.0–2.1). Furthermore, they significantly more often rated ‘quality of treatment by caregiver’ high, than 276/414 (67%) primiparous women who planned a hospital birth and who had care transferred (1.65; 1.2–2.3). No differences were observed for multiparous women who had planned home or hospital birth and who had care transferred. Conclusions Planning home birth is associated to a good experience of quality of care by the caregiver. Transferred planned home birth compared to a transferred planned hospital birth does not lead to a more negative experience of care received from the caregiver. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1410-9) contains supplementary material, which is available to authorized users.
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Witteveen AB, De Cock P, Huizink AC, De Jonge A, Klomp T, Westerneng M, Geerts CC. Pregnancy related anxiety and general anxious or depressed mood and the choice for birth setting: a secondary data-analysis of the DELIVER study. BMC Pregnancy Childbirth 2016; 16:363. [PMID: 27871257 PMCID: PMC5118894 DOI: 10.1186/s12884-016-1158-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 11/14/2016] [Indexed: 11/10/2022] Open
Abstract
Background In several developed countries women with a low risk of complications during pregnancy and childbirth can make choices regarding place of birth. In the Netherlands, these women receive midwife-led care and can choose between a home or hospital birth. The declining rate of midwife-led home births alongside the recent debate on safety of home births in the Netherlands, however, suggest an association of choice of birth place with psychological factors related to safety and risk perception. In this study associations of pregnancy related anxiety and general anxious or depressed mood with (changes in) planned place of birth were explored in low risk women in midwife-led care until the start of labour. Methods Data (n = 2854 low risk women in midwife-led care at the onset of labour) were selected from the prospective multicenter DELIVER study. Women completed the Pregnancy Related Anxiety Questionnaire-Revised (PRAQ-R) to assess pregnancy related anxiety and the EuroQol-6D (EQ-6D) for an anxious and/or depressed mood. Results A high PRAQ-R score was associated with planned hospital birth in nulliparous (aOR 1.92; 95% CI 1.32–2.81) and parous women (aOR 2.08; 95% CI 1.55–2.80). An anxious or depressed mood was associated with planned hospital birth (aOR 1.58; 95% CI 1.20–2.08) and with being undecided (aOR 1.99; 95% CI 1.23–2.99) in parous women only. The majority of women did not change their planned place of birth. Changing from an initially planned home birth to a hospital birth later in pregnancy was, however, associated with becoming anxious or depressed after 35 weeks gestation in nulliparous women (aOR 4.17; 95% CI 1.35–12.89) and with pregnancy related anxiety at 20 weeks gestation in parous women (aOR 3.91; 95% CI 1.32–11.61). Conclusion Low risk women who planned hospital birth (or who were undecided) more often reported pregnancy related anxiety or an anxious or depressed mood. Women who changed from home to hospital birth during pregnancy more often reported pregnancy related anxiety or an anxious or depressed mood in late pregnancy. Anxiety should be adequately addressed in the process of informed decision-making regarding planned place of birth in low risk women.
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Affiliation(s)
- A B Witteveen
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - P De Cock
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - A C Huizink
- Department of Developmental Psychology, VU University Amsterdam, Amsterdam, The Netherlands.,EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands.,Department of Clinical Child and Family Studies, VU University Amsterdam, Amsterdam, The Netherlands
| | - A De Jonge
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - T Klomp
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - M Westerneng
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - C C Geerts
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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What women want: Exploring pregnant women's preferences for alternative models of maternity care. Health Policy 2016; 121:66-74. [PMID: 27884492 DOI: 10.1016/j.healthpol.2016.10.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 10/05/2016] [Accepted: 10/27/2016] [Indexed: 11/21/2022]
Abstract
Depending on obstetric risk, maternity care may be provided in one of two locations at hospital level: a consultant-led unit (CLU) or a midwifery-led unit (MLU). Care in a MLU is sparsely provided in Ireland, comprising as few as two units out of a total 21 maternity units. Given its potential for greater efficiencies of care and cost-savings for the state, there has been an increased interest to expand MLUs in Ireland. Yet, very little is known about women's preferences for midwifery-led care, and whether they would utilise this service when presented with the choice of delivering in a CLU or MLU. This study seeks to involve women in the future planning of maternity care by investigating their preferences for care and subsequent motivations when choosing place of birth. Qualitative research is undertaken to explore maternal preferences for these different models of care. Women only revealed a preference for the MLU when co-located with a CLU due to its close proximity to medical services. However, the results suggest women do not have a clear preference for either model of care, but rather a hybrid model of care which encompasses features of both consultant- and midwifery-led care.
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Hollowell J, Li Y, Malouf R, Buchanan J. Women's birth place preferences in the United Kingdom: a systematic review and narrative synthesis of the quantitative literature. BMC Pregnancy Childbirth 2016; 16:213. [PMID: 27503004 PMCID: PMC4977690 DOI: 10.1186/s12884-016-0998-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 07/29/2016] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Current clinical guidelines and national policy in England support offering 'low risk' women a choice of birth setting, but despite an increase in provison of midwifery units in England the vast majority of women still give birth in obstetric units and there is uncertainty around how best to configure services. There is therefore a need to better understand women's birth place preferences. The aim of this review was to summarise the recent quantitative evidence on UK women's birth place preferences with a focus on identifying the service attributes that 'low risk' women prefer and on identifying which attributes women prioritise when choosing their intended maternity unit or birth setting. METHODS We searched Medline, Embase, PsycINFO, Science Citation Index, Social Science Index, CINAHL and ASSIA to identify quantitative studies published in scientific journals since 1992 and designed to describe and explore women's preferences in relation to place of birth. We included experimental stated preference studies, surveys and mixed-methods studies containing relevant quantitative data, where participants were 'low risk' or 'unselected' groups of women with experience of UK maternity services. RESULTS We included five experimental stated preference studies and four observational surveys, including a total of 4201 respondents. Most studies were old with only three conducted since 2000. Methodological quality was generally poor. The attributes and preferences most commonly explored related to pain relief, continuity of midwife, involvement/availability of medical staff, 'homely' environment/atmosphere, decision-making style, distance/travel time and need for transfer. Service attributes that were almost universally valued by women included local services, being attended by a known midwife and a preference for a degree of control and involvement in decision-making. A substantial proportion of women had a strong preference for care in a hospital setting where medical staff are not necessarily involved in their care, but are readily available. CONCLUSIONS The majority of women appear to value some service attributes while preferences differ for others. Policy makers, commissioners and service providers might usefully consider how to extend the availability of services that most women value while offering a choice of options that enable women to access services that best fit their needs and preferences.
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Affiliation(s)
- Jennifer Hollowell
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
| | - Yangmei Li
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Reem Malouf
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - James Buchanan
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Stevens G, Miller YD, Watson B, Thompson R. Choosing a Model of Maternity Care: Decision Support Needs of Australian Women. Birth 2016; 43:167-75. [PMID: 26661139 DOI: 10.1111/birt.12212] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Access to information on the features and outcomes associated with the various models of maternity care available in Australia is vital for women's informed decision-making. This study sought to identify women's preferences for information access and decision-making involvement, as well as their priority information needs, for model of care decision-making. METHODS A convenience sample of adult women of childbearing age in Queensland, Australia were recruited to complete an online survey assessing their model of care decision support needs. Knowledge on models of care and socio-demographic characteristics were also assessed. RESULTS Altogether, 641 women provided usable survey data. Of these women, 26.7 percent had heard of all available models of care before starting the survey. Most women wanted access to information on models of care (90.4%) and an active role in decision-making (99.0%). Nine priority information needs were identified: cost, access to choice of mode of birth and care provider, after hours provider contact, continuity of carer in labor/birth, mobility during labor, discussion of the pros/cons of medical procedures, rates of skin-to-skin contact after birth, and availability at a preferred birth location. This information encompassed the priority needs of women across age, birth history, and insurance status subgroups. CONCLUSIONS This study demonstrates Australian women's unmet needs for information that supports them to effectively compare available options for model of maternity care. Findings provide clear direction on what information should be prioritized and ideal channels for information access to support quality decision-making in practice.
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Affiliation(s)
- Gabrielle Stevens
- School of Psychology, The University of Queensland, Brisbane, Qld, Australia
| | - Yvette D Miller
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Qld, Australia
| | - Bernadette Watson
- School of Psychology, The University of Queensland, Brisbane, Qld, Australia
| | - Rachel Thompson
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
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The association of birth model with resilience variables and birth experience: Home versus hospital birth. Midwifery 2016; 36:80-5. [PMID: 27106947 DOI: 10.1016/j.midw.2016.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/15/2016] [Accepted: 03/16/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE to study home, natural hospital, and medical hospital births, and the association of these birth models to resilience and birth experience. DESIGN cross-section retrospective design. SETTING participants were recruited via an online survey system. Invitations to participate were posted in five different Internet forums for women on maternity leave, from September 2014 to August 2015. PARTICIPANTS the sample comprised 381 post partum healthy women above the age of 20, during their maternity leave. Of the participants: 22% gave birth at home, 32% gave birth naturally in a hospital, and 46% of the participants had a medical birth at the hospital. MEASUREMENTS life Orientation Test Revised (LOT-R), General Self-Efficacy Scale, Sense of Mastery Scale, Childbirth Experience Questionnaire (CEQ). FINDINGS women having had natural births, whether at home or at the hospital, significantly differed from women having had medical births in all aspects of the birth experience, even when controlling for age and optimism. Birth types contributed to between 14% and 24% of the explained variance of the various birth experience aspects. KEY CONCLUSIONS home and natural hospital births were associated with a better childbirth experience. Optimism was identified as a resilience factor, associated both with preference as well as with childbirth experience. IMPLICATIONS FOR PRACTICE physically healthy and resilient women could be encouraged to explore the prospect of home or natural hospital births as a means to have a more positive birth experience.
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Halfdansdottir B, Olafsdottir OA, Hildingsson I, Smarason AK, Sveinsdottir H. Maternal attitudes towards home birth and their effect on birth outcomes in Iceland: A prospective cohort study. Midwifery 2016; 34:95-104. [PMID: 26809368 DOI: 10.1016/j.midw.2015.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 12/18/2015] [Accepted: 12/30/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE to examine the relationship between attitudes towards home birth and birth outcomes, and whether women's attitudes towards birth and intervention affected this relationship. DESIGN a prospective cohort study. SETTING the study was set in Iceland, a sparsely populated island with harsh terrain, 325,000 inhabitants, high fertility and home birth rates, and less than 5000 births a year. PARTICIPANTS a convenience sample of women who attended antenatal care in Icelandic health care centres, participated in the Childbirth and Health Study in 2009-2011, and expressed consistent attitudes towards home birth (n=809). FINDINGS of the participants, 164 (20.3%) expressed positive attitudes towards choosing home birth and 645 (79.7%) expressed negative attitudes. Women who had a positive attitude towards home birth had significantly more positive attitudes towards birth and more negative attitudes towards intervention than did women who had a negative attitude towards home birth. Of the 340 self-reported low-risk women that answered questionnaires on birth outcomes, 78 (22.9%) had a positive attitude towards home birth and 262 (77.1%) had a negative attitude. Oxytocin augmentation (19.2% (n=15) versus 39.1% (n=100)), epidural analgesia (19.2% (n=15) versus 33.6% (n=88)), and neonatal intensive care unit admission rates (0.0% (n=0) versus 5.0% (n=13)) were significantly lower among women who had a positive attitude towards home birth. Women's attitudes towards birth and intervention affected the relationship between attitudes towards home birth and oxytocin augmentation or epidural analgesia. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE the beneficial effect of planned home birth on maternal outcome in Iceland may depend to some extent on women's attitudes towards birth and intervention. Efforts to de-stigmatise out-of-hospital birth and de-medicalize women's attitudes towards birth might increase women׳s use of health-appropriate birth services.
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Affiliation(s)
- Berglind Halfdansdottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Eirberg, Eiriksgata 34, 101 Reykjavik, Iceland.
| | - Olof A Olafsdottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Eirberg, Eiriksgata 34, 101 Reykjavik, Iceland.
| | - Ingegerd Hildingsson
- Department of Nursing, Mid Sweden University, Holmgatan 10, 851 70 Sundsvall, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Solnavagen 1, 171 77 Stockholm, Sweden; Department of Women's and Children's Health, Uppsala University, Box 256, 751 05 Uppsala, Sweden.
| | - Alexander Kr Smarason
- Institution of Health Science Research, University of Akureyri, Solborg v/Nordurslod, 600 Akureyri, Iceland.
| | - Herdis Sveinsdottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Eirberg, Eiriksgata 34, 101 Reykjavik, Iceland.
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Sluijs AM, Cleiren MP, Scherjon SA, Wijma K. Does fear of childbirth or family history affect whether pregnant Dutch women prefer a home- or hospital birth? Midwifery 2015; 31:1143-8. [DOI: 10.1016/j.midw.2015.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 07/29/2015] [Accepted: 08/02/2015] [Indexed: 11/28/2022]
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Halfdansdottir B, Wilson ME, Hildingsson I, Olafsdottir OA, Smarason AK, Sveinsdottir H. Autonomy in place of birth: a concept analysis. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2015; 18:591-600. [PMID: 25641663 DOI: 10.1007/s11019-015-9624-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This article examines one of the relevant concepts in the current debate on home birth-autonomy in place of birth-and its uses in general language, ethics, and childbirth health care literature. International discussion on childbirth services. A concept analysis guided by the model of Walker and Avant. The authors suggest that autonomy in the context of choosing place of birth is defined by three main attributes: information, capacity and freedom; given the antecedent of not harming others, and the consequences of accountability for the outcome. Model, borderline and contrary cases of autonomy in place of birth are presented. A woman choosing place of birth is autonomous if she receives all relevant information on available choices, risks and benefits, is capable of understanding and processing the information and choosing place of birth in the absence of coercion, provided she intends no harm to others and is accountable for the outcome. The attributes of the definition can serve as a useful tool for pregnant women, midwives, and other health professionals in contemplating their moral status and discussing place of birth.
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Affiliation(s)
| | | | - Ingegerd Hildingsson
- Mid Sweden University, Sundsvall, Sweden
- Karolinska Institutet, Stockholm, Sweden
- Uppsala University, Uppsala, Sweden
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The characteristics of women who birth at home, in a birth centre or in a hospital labour ward: A study of a nationally-representative sample of 1835 pregnant women. SEXUAL & REPRODUCTIVE HEALTHCARE 2015; 6:132-7. [DOI: 10.1016/j.srhc.2015.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 03/27/2015] [Accepted: 04/12/2015] [Indexed: 10/23/2022]
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de Jonge A, Mesman JAJM, Manniën J, Zwart JJ, Buitendijk SE, van Roosmalen J, van Dillen J. Severe Adverse Maternal Outcomes among Women in Midwife-Led versus Obstetrician-Led Care at the Onset of Labour in the Netherlands: A Nationwide Cohort Study. PLoS One 2015; 10:e0126266. [PMID: 25961723 PMCID: PMC4427485 DOI: 10.1371/journal.pone.0126266] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 03/31/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To test the hypothesis that it is possible to select a group of low risk women who can start labour in midwife-led care without having increased rates of severe adverse maternal outcomes compared to women who start labour in secondary care. DESIGN AND METHODS We conducted a nationwide cohort study in the Netherlands, using data from 223 739 women with a singleton pregnancy between 37 and 42 weeks gestation without a previous caesarean section, with spontaneous onset of labour and a child in cephalic presentation. Information on all cases of severe acute maternal morbidity collected by the national study into ethnic determinants of maternal morbidity in the Netherlands (LEMMoN study), 1 August 2004 to 1 August 2006, was merged with data from the Netherlands Perinatal Registry of all births occurring during the same period. Our primary outcome was severe acute maternal morbidity (SAMM, i.e. admission to an intensive care unit, uterine rupture, eclampsia or severe HELLP, major obstetric haemorrhage, and other serious events). Secondary outcomes were postpartum haemorrhage and manual removal of placenta. RESULTS Nulliparous and parous women who started labour in midwife-led care had lower rates of SAMM, postpartum haemorrhage and manual removal of placenta compared to women who started labour in secondary care. For SAMM the adjusted odds ratio's and 95% confidence intervals were for nulliparous women: 0.57 (0.45 to 0.71) and for parous women 0.47 (0.36 to 0.62). CONCLUSIONS Our results suggest that it is possible to identify a group of women at low risk of obstetric complications who may benefit from midwife-led care. Women can be reassured that we found no evidence that midwife-led care at the onset of labour is unsafe for women in a maternity care system with a well developed risk selection and referral system.
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Affiliation(s)
- Ank de Jonge
- Department of Midwifery Science, AVAG and the EMGO Institute of Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | | | - Judith Manniën
- Department of Midwifery Science, AVAG and the EMGO Institute of Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Joost J. Zwart
- Deventer Hospital, Department of Obstetrics, Deventer, the Netherlands
| | | | - Jos van Roosmalen
- Leiden University Medical Center, Department of Obstetrics, Leiden, the Netherlands
- Athena Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Jeroen van Dillen
- Radboud University Medical Center Nijmegen, Department of Obstetrics, Nijmegen, the Netherlands
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Abstract
The objective of this study was to describe nulliparas' reasons for the type of provider (i.e., midwife, physician) and childbirth setting (i.e., home, hospital, hospital-based birth center) that respondents expected for their births. Data were collected via a cross-sectional, descriptive, self-administered, Web-based survey including both close- and open-ended questions and were analyzed using conventional content analysis. Respondents were 220 nulliparous women aged 18-40 years, living in the United States, and pregnant at 20 or fewer weeks' gestation. Women's reasons were categorized broadly as relating to provider/setting attributes, relationship with provider/setting, normative choices, respondent attributes, and practical considerations. Respondents' reasons highlight misconceptions about childbirth care options, especially regarding midwifery and nonhospital settings, which may be addressed by childbirth education.
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Vedam S, Leeman L, Cheyney M, Fisher TJ, Myers S, Low LK, Ruhl C. Transfer from Planned Home Birth to Hospital: Improving Interprofessional Collaboration. J Midwifery Womens Health 2014; 59:624-634. [DOI: 10.1111/jmwh.12251] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Truijens SEM, Wijnen HA, Pommer AM, Oei SG, Pop VJM. Development of the Childbirth Perception Scale (CPS): perception of delivery and the first postpartum week. Arch Womens Ment Health 2014; 17:411-21. [PMID: 24663684 DOI: 10.1007/s00737-014-0420-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 03/02/2014] [Indexed: 10/25/2022]
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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Affiliation(s)
- Sophie E M Truijens
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
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Lindgren H, Kjaergaard H, Olafsdottir OA, Blix E. Praxis and guidelines for planned homebirths in the Nordic countries – An overview. SEXUAL & REPRODUCTIVE HEALTHCARE 2014; 5:3-8. [DOI: 10.1016/j.srhc.2013.12.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 12/05/2013] [Accepted: 12/07/2013] [Indexed: 02/07/2023]
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Geerts CC, Klomp T, Lagro-Janssen ALM, Twisk JWR, van Dillen J, de Jonge A. Birth setting, transfer and maternal sense of control: results from the DELIVER study. BMC Pregnancy Childbirth 2014; 14:27. [PMID: 24438469 PMCID: PMC3898490 DOI: 10.1186/1471-2393-14-27] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 01/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the Netherlands, low risk women receive midwife-led care and can choose to give birth at home or in hospital. There is concern that transfer of care during labour from midwife-led care to an obstetrician-led unit leads to negative birth experiences, in particular among those with planned home birth. In this study we compared sense of control, which is a major attribute of the childbirth experience, for women planning home compared to women planning hospital birth under midwife-led care. In particular, we studied sense of control among women who were transferred to obstetric-led care during labour according to planned place of birth: home versus hospital. METHODS We used data from the prospective multicentre DELIVER (Data EersteLIjns VERloskunde) cohort-study, conducted in 2009 and 2010 in the Netherlands. Sense of control during labour was assessed 6 weeks after birth, using the short version of the Labour Agentry Scale (LAS-11). A higher LAS-11 score indicates a higher feeling of control. We considered a difference of a minimum of 5.5 points as clinically relevant. RESULTS Nulliparous- and parous women who planned a home birth had a 2.6 (95% CI 1.0, 4.3) and a 3.0 (1.6, 4.4) higher LAS score during first stage of labour respectively and during second stage a higher score of 2.8 (0.9, 4.7) and 2.3 (0.6, 4.0), compared with women who planned a hospital birth. Overall, women who were transferred experienced a lower sense of control than women who were not transferred. Parous women who planned a home birth and who were transferred had a 4.3 (0.2, 8.4) higher LAS score in 2nd stage, compared to those who planned a hospital birth and who were transferred. CONCLUSION We found no clinically relevant differences in feelings of control among women who planned a home or hospital birth. Transfer of care during labour lowered feelings of control, but feelings of control were similar for transferred women who planned a home or hospital birth.As far as their expected sense of control is concerned, low risk women should be encouraged to give birth at the location of their preference.
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Affiliation(s)
- Caroline C Geerts
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, the Netherlands.
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Truijens SEM, Pommer AM, van Runnard Heimel PJ, Verhoeven CJM, Oei SG, Pop VJM. Development of the Pregnancy and Childbirth Questionnaire (PCQ): evaluating quality of care as perceived by women who recently gave birth. Eur J Obstet Gynecol Reprod Biol 2013; 174:35-40. [PMID: 24332094 DOI: 10.1016/j.ejogrb.2013.11.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 11/07/2013] [Accepted: 11/20/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To develop an instrument to the assess quality of care during pregnancy and delivery as perceived by women who recently gave birth. STUDY DESIGN Prospective design from focus group interviews to validation of the questionnaire. The focus groups consisted of seven care providers, ten pregnant women and six women who recently gave birth. With the results of the focus group interviews, a draft questionnaire of 52 items was composed and its psychometric properties were tested in a first cohort of 300 women who recently gave birth (sample I) by means of exploratory factor analysis (EFA) and reliability analysis. The final version was further explored by confirmatory factor analyses (CFA) in another sample of 289 women (sample II) with similar characteristics as sample I. RESULTS EFA in sample I suggested an 18-item scale with two components concerning the quality of care during pregnancy: 'personal treatment' (11 items, Cronbach's alpha (α)=0.87) and 'educational information' (7 items, α=0.90); the 'delivery' scale showed a single domain (7 items, α=0.88). CFA in sample II confirmed both factor structures with an adequate model fit. Overall, satisfaction with care was highest among women who only received midwife-led care, while women who were referred to an obstetrician during pregnancy reported less satisfaction. CONCLUSIONS The 25-item PCQ, primarily based on the experiences and perceptions of pregnant women and women who recently gave birth, showed adequate psychometric properties evaluating the quality of care during pregnancy and delivery. This user-friendly instrument might be a valuable instrument for future research to further evaluate the quality of care to pregnant women.
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Affiliation(s)
- Sophie E M Truijens
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands.
| | - Antoinette M Pommer
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | | | - Corine J M Verhoeven
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - S Guid Oei
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Victor J M Pop
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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Morrell C, Cantrell A, Evans K, Carrick-Sen D. A review of instruments to measure health-related quality of life and well-being among pregnant women. J Reprod Infant Psychol 2013. [DOI: 10.1080/02646838.2013.835795] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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De Vries R, Nieuwenhuijze M, Buitendijk SE. What does it take to have a strong and independent profession of midwifery? Lessons from the Netherlands. Midwifery 2013; 29:1122-8. [PMID: 23916404 DOI: 10.1016/j.midw.2013.07.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 06/28/2013] [Accepted: 07/04/2013] [Indexed: 11/15/2022]
Abstract
In the 1970s, advocates of demedicalising pregnancy and birth 'discovered' Dutch maternity care. The Netherlands presented an attractive model because its maternity care system was characterised by a strong and independent profession of midwifery, close co-operation between obstetricians and midwives, a very high rate of births at home, little use of caesarean section, and morbidity and mortality statistics that were among the best in the developed world. Over the course of the following 40 years much has changed in the Netherlands. Although the home birth rate remains quite high when compared to other modern countries, it is half of what it was in the 1970s. Midwifery is still an independent medical profession, but a move toward 'integrated care' threatens to bring midwives into hospitals under the direction of medical specialists, more women are interested in medical pain relief, and there is a growing concern that current, albeit slight, increases in rates of intervention in physiological births foreshadow the end of the unique approach to birth in the Netherlands. The story of Dutch maternity care thus offers an ideal opportunity to examine the social, organisational, and cultural factors that work to support, and to diminish, the independent practice of midwifery in high-resource countries. We may wish to believe that providing ample and convincing evidence of the value of midwifery care will be enough to promote more and better use of midwifery, but the lessons from the Netherlands make clear that an array of social forces play a critical role determining the place of midwives in the health care system and how the care they provide is deployed.
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Affiliation(s)
- Raymond De Vries
- Faculty of Midwifery Education & Studies, Zuyd University, Maastricht, Netherlands; CAPHRI, School for Public Health and Primary Care, Maastricht University, Netherlands; Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
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de Jonge A, Mesman JAJM, Manniën J, Zwart JJ, van Dillen J, van Roosmalen J. Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study. BMJ 2013; 346:f3263. [PMID: 23766482 PMCID: PMC3685517 DOI: 10.1136/bmj.f3263] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To test the hypothesis that low risk women at the onset of labour with planned home birth have a higher rate of severe acute maternal morbidity than women with planned hospital birth, and to compare the rate of postpartum haemorrhage and manual removal of placenta. DESIGN Cohort study using a linked dataset. SETTING Information on all cases of severe acute maternal morbidity in the Netherlands collected by the national study into ethnic determinants of maternal morbidity in the netherlands (LEMMoN study), 1 August 2004 to 1 August 2006, merged with data from the Netherlands perinatal register of all births occurring during the same period. PARTICIPANTS 146 752 low risk women in primary care at the onset of labour. MAIN OUTCOME MEASURES Severe acute maternal morbidity (admission to an intensive care unit, eclampsia, blood transfusion of four or more packed cells, and other serious events), postpartum haemorrhage, and manual removal of placenta. RESULTS Overall, 92 333 (62.9%) women had a planned home birth and 54 419 (37.1%) a planned hospital birth. The rate of severe acute maternal morbidity among planned primary care births was 2.0 per 1000 births. For nulliparous women the rate for planned home versus planned hospital birth was 2.3 versus 3.1 per 1000 births (adjusted odds ratio 0.77, 95% confidence interval 0.56 to 1.06), relative risk reduction 25.7% (95% confidence interval -0.1% to 53.5%), the rate of postpartum haemorrhage was 43.1 versus 43.3 (0.92, 0.85 to 1.00 and 0.5%, -6.8% to 7.9%), and the rate of manual removal of placenta was 29.0 versus 29.8 (0.91, 0.83 to 1.00 and 2.8%, -6.1% to 11.8%). For parous women the rate of severe acute maternal morbidity for planned home versus planned hospital birth was 1.0 versus 2.3 per 1000 births (0.43, 0.29 to 0.63 and 58.3%, 33.2% to 87.5%), the rate of postpartum haemorrhage was 19.6 versus 37.6 (0.50, 0.46 to 0.55 and 47.9%, 41.2% to 54.7%), and the rate of manual removal of placenta was 8.5 versus 19.6 (0.41, 0.36 to 0.47 and 56.9%, 47.9% to 66.3%). CONCLUSIONS Low risk women in primary care at the onset of labour with planned home birth had lower rates of severe acute maternal morbidity, postpartum haemorrhage, and manual removal of placenta than those with planned hospital birth. For parous women these differences were statistically significant. Absolute risks were small in both groups. There was no evidence that planned home birth among low risk women leads to an increased risk of severe adverse maternal outcomes in a maternity care system with well trained midwives and a good referral and transportation system.
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Affiliation(s)
- Ank de Jonge
- Department of Midwifery Science, AVAG and the EMGO Institute of Health and Care Research, VU University Medical Center, Amsterdam, Netherlands.
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Niemczyk NA. Postpartum hemorrhages are more common in planned hospital births compared with planned home births. J Midwifery Womens Health 2013; 58:347-8. [PMID: 23656427 DOI: 10.1111/jmwh.12056_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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