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Scheefhals ZTM, de Vries EF, Molenaar JM, Numans ME, Struijs JN. Observational Data for Integrated Maternity Care: Experiences with a Data-Infrastructure for Parents and Children in the Netherlands. Int J Integr Care 2023; 23:20. [PMID: 38145057 PMCID: PMC10742107 DOI: 10.5334/ijic.7012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/30/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction Observational data are increasingly seen as a valuable source for integrated care research. Especially since the growing availability of routinely collected data and quasi-experimental methods. The aim of this paper is to describe the potentials and challenges when using observational data for integrated maternity care research, based on our experience from developing and working with the Data-InfrAstructure for ParEnts and childRen (DIAPER). Methods and Results We provide a description of DIAPER, which is a linked data-infrastructure on the individual level based on maternity care claims data, quality and utilization of maternity care and data from municipal registries, covering the life course from preconception to adulthood. We then discuss potentials and practical applications of DIAPER such as to evaluate alternative payment models for integrated maternity care, to set the policy agenda regarding postpartum care, to provide insights into value of care and into provider variation, and to evaluate (policy) interventions designed to promote and support integrated maternity care. This is relevant for several stakeholders: policy makers, payers, providers and clients/patients. Based on experiences with DIAPER, we identify remaining challenges: missing data sources (especially self-reported outcomes), suboptimal quality of data, privacy concerns and potential biases introduced during data linkage, and describe how these challenges were tackled within the applications of DIAPER. Conclusions With DIAPER we demonstrated that using observational data can be of added value for integrated care research, but also that challenges remain. It is essential to keep exploring and developing the possibilities of observational data and continue the discussions in the scientific community. Learning from each other's successes and failures will be critical.
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Affiliation(s)
- Zoë T. M. Scheefhals
- Department of National Health and Healthcare, National Institute for Public Health and the Environment (RIVM), The Netherlands
- Department of Public Health and Primary Care, LUMC Health Campus The Hague, The Netherlands
| | - Eline F. de Vries
- Department of Health Economics and Healthcare, National Institute for Public Health and the Environment (RIVM), The Netherlands
| | - Joyce M. Molenaar
- Department of National Health and Healthcare, National Institute for Public Health and the Environment (RIVM), The Netherlands
- Department of Public Health and Primary Care, LUMC Health Campus The Hague, The Netherlands
| | - Mattijs E. Numans
- Department of Public Health and Primary Care, LUMC Health Campus The Hague, The Netherlands
| | - Jeroen N. Struijs
- Department of National Health and Healthcare, National Institute for Public Health and the Environment (RIVM), The Netherlands
- Department of Public Health and Primary Care, LUMC Health Campus The Hague, The Netherlands
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Offerhaus P, van Haaren-Ten Haken TM, Keulen JKJ, de Jong JD, Brabers AEM, Verhoeven CJM, Scheepers HCJ, Nieuwenhuijze M. Regional practice variation in induction of labor in the Netherlands: Does it matter? A multilevel analysis of the association between induction rates and perinatal and maternal outcomes. PLoS One 2023; 18:e0286863. [PMID: 37289749 PMCID: PMC10249899 DOI: 10.1371/journal.pone.0286863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 05/25/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Practice variation in healthcare is a complex issue. We focused on practice variation in induction of labor between maternity care networks in the Netherlands. These collaborations of hospitals and midwifery practices are jointly responsible for providing high-quality maternity care. We explored the association between induction rates and maternal and perinatal outcomes. METHODS In a retrospective population-based cohort study, we included records of 184,422 women who had a singleton, vertex birth of their first child after a gestation of at least 37 weeks in the years 2016-2018. We calculated induction rates for each maternity care network. We divided networks in induction rate categories: lowest (Q1), moderate (Q2-3) and highest quartile (Q4). We explored the association of these categories with unplanned caesarean sections, unfavorable maternal outcomes and adverse perinatal outcomes using descriptive statistics and multilevel logistic regression analysis corrected for population characteristics. FINDINGS The induction rate ranged from 14.3% to 41.1% (mean 24.4%, SD 5.3). Women in Q1 had fewer unplanned caesarean sections (Q1: 10.2%, Q2-3: 12.1%; Q4: 12.8%), less unfavorable maternal outcomes (Q1: 33.8%; Q2-3: 35.7%; Q4: 36.3%) and less adverse perinatal outcomes (Q1: 1.0%; Q2-3: 1.1%; Q4: 1.3%). The multilevel analysis showed a lower unplanned caesarean section rate in Q1 in comparison with reference category Q2-3 (OR 0.83; p = .009). The unplanned caesarean section rate in Q4 was similar to the reference category. No significant associations with unfavorable maternal or adverse perinatal outcomes were observed. CONCLUSION Practice variation in labor induction is high in Dutch maternity care networks, with limited association with maternal outcomes and no association with perinatal outcomes. Networks with low induction rates had lower unplanned caesarean section rates compared to networks with moderate rates. Further in-depth research is necessary to understand the mechanisms that contribute to practice variation and the observed association with unplanned caesarean sections.
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Affiliation(s)
- Pien Offerhaus
- Research Centre for Midwifery Science, Zuyd University, Maastricht, the Netherlands
| | | | - Judit K. J. Keulen
- Research Centre for Midwifery Science, Zuyd University, Maastricht, the Netherlands
| | - Judith D. de Jong
- Nivel–Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Anne E. M. Brabers
- Nivel–Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Corine J. M. Verhoeven
- Department of Midwifery Science, Amsterdam University Medical Centre (UMC), Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
- Department of General Practice & Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, the Netherlands
| | - Hubertina C. J. Scheepers
- Department of Obstetrics and Gynecology, GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Marianne Nieuwenhuijze
- Research Centre for Midwifery Science, Zuyd University, Maastricht, the Netherlands
- Maastricht University, Care and Public Health Research Institute, Maastricht, the Netherlands
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Niessink-Beckers S, Verhoeven CJ, Nahuis MJ, Horvat-Gitsels LA, Gitsels-van der Wal JT. Maternal characteristics associated with referral to obstetrician-led care in low-risk pregnant women in the Netherlands: A retrospective cohort study. PLoS One 2023; 18:e0282883. [PMID: 36921011 PMCID: PMC10016726 DOI: 10.1371/journal.pone.0282883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/27/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND In the Netherlands, maternity care is divided into midwife-led care (for low-risk women) and obstetrician-led care (for high-risk women). Referrals from midwife-led to obstetrician-led care have increased over the past decade. The majority of women are referred during their pregnancy or labour. Referrals are based on a continuous risk assessment of the health and characteristics of mother and child, yet referral for non-medical factors and characteristics remain unclear. This study investigated which maternal characteristics are associated with women's referral from midwife-led to obstetrician-led care. MATERIALS AND METHODS A retrospective cohort study in one midwife-led care practice in the Netherlands included 1096 low-risk women during January 2015-17. The primary outcomes were referral from midwife-led to obstetrician-led care in (1) the antepartum period and (2) the intrapartum period. In total, 11 maternal characteristics were identified. Logistic regression models of referral in each period were fitted and stratified by parity. RESULTS In the antepartum period, referral among nulliparous women was associated with an older maternal age (aOR, 1.07; 95%CI, 1.05-1.09), being underweight (0.45; 0.31-0.64), overweight (2.29; 1.91-2.74), or obese (2.65; 2.06-3.42), a preconception period >1 year (1.34; 1.07-1.66), medium education level (0.76; 0.58-1.00), deprivation (1.87; 1.54-2.26), and sexual abuse (1.44; 1.14-1.82). Among multiparous women, a referral was associated with being underweight (0.40; 0.26-0.60), obese (1.61; 1.30-1.98), a preconception period >1 year (1.71; 1.27-2.28), employment (1.38; 1.19-1.61), deprivation (1.23; 1.03-1.46), highest education level (0.63; 0.51-0.80), psychological problems (1.24; 1.06-1.44), and one or multiple consultations with an obstetrician (0.68; 0.58-0.80 and 0.64; 0.54-0.76, respectively). In the intrapartum period, referral among nulliparous women was associated with an older maternal age (1.02; 1.00-1.05), being underweight (1.67; 1.15-2.42), a preconception period >1 year (0.42; 0.31-0.57), medium or high level of education (2.09; 1.49-2.91 or 1.56; 1.10-2.22, respectively), sexual abuse (0.46; 0.33-0.63), and multiple consultations with an obstetrician (1.49; 1.15-1.94). Among multiparous women, referral was associated with an older maternal age (1.02; 1.00-1.04), being overweight (0.65; 0.51-0.83), a preconception period >1 year (0.33; 0.17-0.65), non-Dutch ethnicity (1.98; 1.61-2.45), smoking (0.75; 0.57-0.97), sexual abuse (1.49; 1.09-2.02), and one or multiple consultations with an obstetrician (1.34; 1.06-1.70 and 2.09; 1.63-2.69, respectively). CONCLUSIONS This exploratory study showed that several non-medical maternal characteristics of low-risk pregnant women are associated with referral from midwife-led to obstetrician-led care, and how these differ by parity and partum period.
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Affiliation(s)
- Susan Niessink-Beckers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- * E-mail:
| | - Corine J. Verhoeven
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven, Netherlands
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Marleen J. Nahuis
- Department of Obstetrics and Gynecology, Noordwest Hospital Group location Alkmaar, Alkmaar, Netherlands
| | - Lisanne A. Horvat-Gitsels
- UCL Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Janneke T. Gitsels-van der Wal
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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4
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Weiland S, Peters LL, Berger MY, Erwich JJHM, Jansen DEMC. Women who smoke during pregnancy are more likely to be referred to an obstetrician during pregnancy and birth: results from a cohort study. BMC Pregnancy Childbirth 2022; 22:479. [PMID: 35698051 PMCID: PMC9190098 DOI: 10.1186/s12884-022-04808-7] [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: 11/30/2021] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background Women who smoke during pregnancy make less use of prenatal care; the relation of smoking behavior with the use of other forms of maternal healthcare is unknown. The objective of this study is to investigate the association between women’s smoking behavior and their use of healthcare during pregnancy, birth and six weeks postpartum. Methods We analyzed data from the Dutch Midwifery Case Registration System (VeCaS), period 2012–2019. We included women with a known smoking status, singleton pregnancies, and who had their first appointment before 24 weeks of gestation with the primary care midwife. We compared three groups: non-smokers, early stoppers (stopped smoking in the first trimester), and late- or non-stoppers (stopped smoking after the first trimester or continued smoking). Descriptive statistics were used to report maternal healthcare utilization (during pregnancy, birth and six weeks postpartum), statistical differences between the groups were calculated with Kruskal–Wallis tests. Multivariable logistic regression was conducted to assess the association between smoking behavior and referrals to primary, secondary or tertiary care. Results We included 41 088 pregnant women. The groups differed significantly on maternal healthcare utilization. The late- or non-stoppers initiated prenatal care later and had less face-to-face consultations with primary care midwives during pregnancy. Compared to the non-smokers, the early- and late- or non-stoppers were statistically signficiantly more likely to be referred to the obstetrician during pregnancy and birth. Postpartum, the early- and late- or non-stoppers were statistically signficantly less likely to be referred to the obstetrician compared to the non-smokers. Conclusions Although the early- and late- or non-stoppers initiated prenatal care later than the non-smokers, they did receive adequate prenatal care (according to the recommendations). The results suggest that not smoking during pregnancy may decrease the likelihood of referral to secondary or tertiary care. The large population of smokers being referred during pregnancy underlines the important role of the collaboration between healthcare professionals in primary and secondary or tertiary care. They need to be more aware of the importance of smoking as a medical and as a non-medical risk factor.
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Affiliation(s)
- S Weiland
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands. .,Department of Midwifery Science AVAG, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - L L Peters
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.,Department of Midwifery Science AVAG, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - M Y Berger
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - J J H M Erwich
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - D E M C Jansen
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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5
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Offerhaus P, Jans S, Hukkelhoven C, de Vries R, Nieuwenhuijze M. Women's characteristics and care outcomes of caseload midwifery care in the Netherlands: a retrospective cohort study. BMC Pregnancy Childbirth 2020; 20:517. [PMID: 32894082 PMCID: PMC7487921 DOI: 10.1186/s12884-020-03204-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/21/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The maternity care system in the Netherlands is well known for its support of community-based midwifery. However, regular midwifery practices typically do not offer caseload midwifery care - one-to-one continuity of care throughout pregnancy and birth. Because we know very little about the outcomes for women receiving caseload care in the Netherlands, we compared caseload care with regular midwife-led care, looking at maternal and perinatal outcomes, including antenatal and intrapartum referrals to secondary (i.e., obstetrician-led) care. METHODS We selected 657 women in caseload care and 1954 matched controls (women in regular midwife-led care) from all women registered in the Dutch Perinatal Registry (Perined) who gave birth in 2015. To be eligible for selection the women had to be in midwife-led antenatal care beyond 28 gestational weeks. Each woman in caseload care was matched with three women in regular midwife-led care, using parity, maternal age, background (Dutch or non-Dutch) and region. These two cohorts were compared for referral rates, mode of birth, and other maternal and perinatal outcomes. RESULTS In caseload midwifery care, 46.9% of women were referred to obstetrician-led care (24.2% antenatally and 22.8% in the intrapartum period). In the matched cohort, 65.7% were referred (37.4% antenatally and 28.3% in the intrapartum period). In caseload care, 84.0% experienced a spontaneous vaginal birth versus 77.0% in regular midwife-led care. These patterns were observed for both nulliparous and multiparous women. Women in caseload care had fewer inductions of labour (13.2% vs 21.0%), more homebirths (39.4% vs 16.1%) and less perineal damage (intact perineum: 41.3% vs 28.2%). The incidence of perinatal mortality and a low Apgar score was low in both groups. CONCLUSIONS We found that when compared to regular midwife-led care, caseload midwifery care in the Netherlands is associated with a lower referral rate to obstetrician-led care - both antenatally and in the intrapartum period - and a higher spontaneous vaginal birth rate, with similar perinatal safety. The challenge is to include this model as part of the current effort to improve the quality of Dutch maternity care, making caseload care available and affordable for more women.
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Affiliation(s)
- Pien Offerhaus
- Research Centre for Midwifery Science, Midwifery Education and Studies Maastricht, ZUYD University, Universiteitssingel 60, 6229 ER Maastricht, the Netherlands
| | - Suze Jans
- TNO, Department of Child Health, Schipholweg 77, 2316 ZL Leiden, The Netherlands
| | | | - Raymond de Vries
- Research Centre for Midwifery Science, Midwifery Education and Studies Maastricht, ZUYD University, Universiteitssingel 60, 6229 ER Maastricht, the Netherlands
- CAPHRI (School for Public Health and Primary Care), Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, 2800 Plymouth Road, Building 14, CBSSM, Ann Arbor, MI 48109-2800 USA
| | - Marianne Nieuwenhuijze
- Research Centre for Midwifery Science, Midwifery Education and Studies Maastricht, ZUYD University, Universiteitssingel 60, 6229 ER Maastricht, the Netherlands
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Goodarzi B, Walker A, Holten L, Schoonmade L, Teunissen P, Schellevis F, de Jonge A. Towards a better understanding of risk selection in maternal and newborn care: A systematic scoping review. PLoS One 2020; 15:e0234252. [PMID: 32511258 PMCID: PMC7279596 DOI: 10.1371/journal.pone.0234252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/21/2020] [Indexed: 01/21/2023] Open
Abstract
Globally, millions of women and their children suffer due to preventable morbidity and mortality, associated with both underuse and overuse of maternal and newborn care. An effective system of risk selection that differentiates between what care should be provided and who should provide it is a global necessity to ensure women and children receive appropriate care, at the right place and the right time. Poor conceptualization of risk selection impedes evaluation and comparison of models of risk selection across various settings, which is necessary to improve maternal and newborn care. We conducted a scoping review to enhance the understanding of risk selection in maternal and newborn care. We included 210 papers, published over the past four decades, originating from 24 countries. Using inductive thematic analysis, we identified three main dimensions of risk selection: (1) risk selection as an organisational measure to optimally align women's and children's needs and resources, (2) risk selection as a practice to detect and assess risk and to make decisions about the delivery of care, and (3) risk selection as a tool to ensure safe care. We found that these three dimensions have three themes in common: risk selection (1) is viewed as both requiring and providing regulation, (2) has a provider centred focus and (3) aims to avoid underuse of care. Due to the methodological challenges of contextual diversity, the concept of risk selection needs clear indicators that capture the complexity of care to make cross-setting evaluation and comparison of risk selection possible. Moreover, a comprehensive understanding of risk selection needs to consider access disparity, women's needs, and unnecessary medicalization.
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Affiliation(s)
- Bahareh Goodarzi
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annika Walker
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lianne Holten
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Linda Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim Teunissen
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - François Schellevis
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Ank de Jonge
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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7
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Seijmonsbergen-Schermers AE, Zondag DC, Nieuwenhuijze M, van den Akker T, Verhoeven CJ, Geerts CC, Schellevis FG, de Jonge A. Regional variations in childbirth interventions and their correlations with adverse outcomes, birthplace and care provider: A nationwide explorative study. PLoS One 2020; 15:e0229488. [PMID: 32134957 PMCID: PMC7058301 DOI: 10.1371/journal.pone.0229488] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 02/07/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Variations in childbirth interventions may indicate inappropriate use. Most variation studies are limited by the lack of adjustments for maternal characteristics and do not investigate variations in adverse outcomes. This study aims to explore regional variations in the Netherlands and their correlations with referral rates, birthplace, interventions, and adverse outcomes, adjusted for maternal characteristics. METHODS In this nationwide retrospective cohort study, using a national data register, intervention rates were analysed between twelve regions among single childbirths after 37 weeks' gestation in 2010-2013 (n = 614,730). These were adjusted for maternal characteristics using multivariable logistic regression. Primary outcomes were intrapartum referral, birthplace, and interventions used in midwife- and obstetrician-led care. Correlations both between primary outcomes and between adverse outcomes were calculated with Spearman's rank correlations. FINDINGS Intrapartum referral rates varied between 55-68% (nulliparous) and 20-32% (multiparous women), with a negative correlation with receiving midwife-led care at the onset of labour in two-thirds of the regions. Regions with higher referral rates had higher rates of severe postpartum haemorrhages. Rates of home birth varied between 6-16% (nulliparous) and 16-31% (multiparous), and was negatively correlated with episiotomy and postpartum oxytocin rates. Among midwife-led births, episiotomy rates varied between 14-42% (nulliparous) and 3-13% (multiparous) and in obstetrician-led births from 46-67% and 14-28% respectively. Rates of postpartum oxytocin varied between 59-88% (nulliparous) and 50-85% (multiparous) and artificial rupture of membranes between 43-52% and 54-61% respectively. A north-south gradient was visible with regard to birthplace, episiotomy, and oxytocin. CONCLUSIONS Our study suggests that attitudes towards interventions vary, independent of maternal characteristics. Care providers and policy makers need to be aware of reducing unwarranted variation in birthplace, episiotomy and the postpartum use of oxytocin. Further research is needed to identify explanations and explore ways to reduce unwarranted intervention rates.
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Affiliation(s)
- Anna E. Seijmonsbergen-Schermers
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Dirkje C. Zondag
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Corine J. Verhoeven
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Caroline C. Geerts
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - François G. Schellevis
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ank de Jonge
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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8
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Ghardallou M, Limam M, Khelifi A, Khairi O, Khairi H, Mtiraoui A, NabliAjmi T. Obstetric referrals to a tertiary care maternity: a descriptive study. Pan Afr Med J 2019; 33:306. [PMID: 31692846 PMCID: PMC6815507 DOI: 10.11604/pamj.2019.33.306.16906] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 07/31/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction An effective referral system is considered as a key to saving mothers' and children's lives. The aims of this study were to determine the frequency and the indications of obstetric referrals in a Tunisian tertiary care maternity and to assess the conformity of referral mechanisms with the National Perinatality Programme (NPP) guidelines. Methods A descriptive study was undertaken among women referred to Farhat Hached University Hospital in Sousse, Tunisia with antenatal complications requiring urgent delivery and those referred while in labour or with immediate post partum complications. The ICD-10 was used to code recorded indications and diagnoses for referrals. Results Referrals represents 15.23% of the obstetric activity in this facility. There were 32 reasons for referrals with the most common being premature rupture of membranes (14.1%) and fetal distress (13.5%). A fifth of the referrals were unclassifiable according to ICD-10. Most of the indications for referrals (95.8%) did not conform to the list of referral indications of the NPP. Twenty eight diagnoses were retained after referrals: the most common of which were prolonged pregnancy (29.5%) and premature rupture of membranes (19.3%). In 41% of women, reasons for referral did not match with diagnoses established at the time of the patients' admission to hospital. Conclusion The current referral system in the region of Sousse still faces several challenges that need to be addressed in order to make it more effective.
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Affiliation(s)
- Mariem Ghardallou
- Université de Sousse, Faculté de Médecine de Sousse, Département de Médecine Communautaire et Familiale, 4000, Sousse, Tunisie.,Université de Sousse, Faculté de Médecine de Sousse, Laboratoire de Recherche en Qualité des Soins Maternelles, "LR12ES03", 4000, Sousse, Tunisie
| | - Manel Limam
- Université de Sousse, Faculté de Médecine de Sousse, Département de Médecine Communautaire et Familiale, 4000, Sousse, Tunisie
| | - Abdejelil Khelifi
- Université de Sousse, Faculté de Médecine de Sousse, Laboratoire de Recherche en Qualité des Soins Maternelles, "LR12ES03", 4000, Sousse, Tunisie.,Université de Sousse, Faculté de Médecine de Sousse, Département d'Obstétrique et de Gynécologie, Hôpital Universitaire Farhat Hached, 4000, Sousse, Tunisie
| | - Ons Khairi
- Université de Sousse, Faculté de Médecine de Sousse, Département de Médecine Communautaire et Familiale, 4000, Sousse, Tunisie
| | - Hédi Khairi
- Université de Sousse, Faculté de Médecine de Sousse, Laboratoire de Recherche en Qualité des Soins Maternelles, "LR12ES03", 4000, Sousse, Tunisie.,Université de Sousse, Faculté de Médecine de Sousse, Département d'Obstétrique et de Gynécologie, Hôpital Universitaire Farhat Hached, 4000, Sousse, Tunisie
| | - Ali Mtiraoui
- Université de Sousse, Faculté de Médecine de Sousse, Département de Médecine Communautaire et Familiale, 4000, Sousse, Tunisie.,Université de Sousse, Faculté de Médecine de Sousse, Laboratoire de Recherche en Qualité des Soins Maternelles, "LR12ES03", 4000, Sousse, Tunisie
| | - Thouraya NabliAjmi
- Université de Sousse, Faculté de Médecine de Sousse, Département de Médecine Communautaire et Familiale, 4000, Sousse, Tunisie.,Université de Sousse, Faculté de Médecine de Sousse, Laboratoire de Recherche en Qualité des Soins Maternelles, "LR12ES03", 4000, Sousse, Tunisie
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9
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Boesveld IC, Hermus MAA, van der Velden-Bollemaat EC, Hitzert M, de Graaf HJ, Franx A, Wiegers TA. An approach to assessing the quality of birth centres results of the Dutch birth centre study. Midwifery 2018; 66:36-48. [PMID: 30121477 DOI: 10.1016/j.midw.2018.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 06/10/2018] [Accepted: 07/22/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE to determine the usability of a recently developed set of 30 structure and process birth centre quality indicators. DESIGN an explorative study using mixed-methods including literature, a survey, interviews and observations. The study is part of the Dutch Birth Centre Study. We first determined the measurability of birth centre quality indicators by describing them in detail. Next, we assessed the birth centres in the Netherlands according to these indicators using data derived from the Dutch Birth Centre General Questionnaire, the Dutch Birth Centre Integration Questionnaire, interviews, and policy documents. SETTING AND PARTICIPANTS representatives of 23 birth centres in the Netherlands. MEASUREMENTS AND FINDINGS 28 of the 30 quality indicators could be used to assess birth centres in the Netherlands, one had no optimal value defined, another could not be scored because the information was not available. Each quality indicator could be scored 0 or 1. Differences between birth centres were shown: the scores ranged from 7 to 22. Some of the quality indicators can be combined or made more specific so that they are easier to assess. Some quality indicators need adaptation because they are only applicable for some birth centres (e.g. only for freestanding or alongside birth centres). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE 28 of the 30 quality indicators are usable to assess structure and process quality of birth centres. With the findings of this study the set of structure and process quality indicators for birth centres in the Netherlands can be reduced to 22 indicators. This set of quality indicators can contribute to the development of a quality system for birth centres. Further research is necessary to formulate standards or minimum quality requirements for birth centres and to improve the set of birth centre quality indicators.
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Affiliation(s)
- Inge C Boesveld
- Jan van Es Institute (Netherlands Expert Centre Integrated Primary Care), Wisselweg 33, 1314 CB Almere, The Netherlands.
| | - Marieke A A Hermus
- Department of Child Health, TNO, PO Box 2215, 2301 CE Leiden, The Netherlands; Department of Obstetrics, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands; Midwifery Practice Trivia, Werkmansbeemd 2, 4907 EW Oosterhout, The Netherlands
| | | | - Marit Hitzert
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, PO Box 2014, 3000 CA Rotterdam, The Netherlands
| | - Hanneke J de Graaf
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, PO Box 2014, 3000 CA Rotterdam, The Netherlands
| | - Arie Franx
- Division Woman and Baby, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, the The Netherlands
| | - Therese A Wiegers
- NIVEL (Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands
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10
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Seijmonsbergen-Schermers AE, Zondag DC, Nieuwenhuijze M, Van den Akker T, Verhoeven CJ, Geerts C, Schellevis F, De Jonge A. Regional variations in childbirth interventions in the Netherlands: a nationwide explorative study. BMC Pregnancy Childbirth 2018; 18:192. [PMID: 29855270 PMCID: PMC5984340 DOI: 10.1186/s12884-018-1795-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/30/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Although interventions in childbirth are important in order to prevent neonatal and maternal morbidity and mortality, non-indicated use may cause avoidable harm. Regional variations in intervention rates, which cannot be explained by maternal characteristics, may indicate over- and underuse. The aim of this study is to explore regional variations in childbirth interventions in the Netherlands and their associations with interventions and adverse outcomes, controlled for maternal characteristics. METHODS Childbirth intervention rates were compared between twelve Dutch regions, using data from the national perinatal birth register for 2010-2013. All single childbirths from 37 weeks' gestation onwards were included. Primary outcomes were induction and augmentation of labour, pain medication, instrumental birth, caesarean section (prelabour, intrapartum) and paediatric involvement. Secondary outcomes were adverse neonatal and maternal outcomes. Multivariable logistic regression analyses were used to adjust for maternal characteristics. Associations were expressed in Spearman's rank correlation coefficients. RESULTS Most variation was found for type of pain medication and paediatric involvement. Epidural analgesia rates varied from between 12 and 38% (nulliparous) and from between 5 and 14% (multiparous women). These rates were negatively correlated with rates of other pharmacological pain relief, which varied from between 15 and 43% (nulliparous) and from between 10 and 27% (multiparous). Rates of paediatric involvement varied from between 37 and 60% (nulliparous) and from between 26 and 43% (multiparous). For instrumental vaginal births, rates varied from between 16 and 19% (nulliparous) and from between 3 and 4% (multiparous). For intrapartum caesarean section, the variation was 13-15% and 5-6%, respectively. A positive correlation was found between intervention rates in midwife-led and obstetrician-led care at the onset of labour within the same region. Adverse neonatal and maternal outcomes were not lower in regions with higher intervention rates. Higher augmentation of labour rates correlated with higher rates of severe postpartum haemorrhage. CONCLUSIONS Most variation was found for type of pain medication and paediatric involvement, and least for instrumental vaginal births and intrapartum caesarean sections. Care providers and policy makers should critically audit remarkable variations, since these may be unwarranted. Limited variation for some interventions may indicate consensus for their use. Further research should focus on variations in evidence-based interventions and indications for the use of interventions in childbirth.
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Affiliation(s)
- A. E. Seijmonsbergen-Schermers
- Department of Midwifery Science, AVAG, Amsterdam Public Health research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - D. C. Zondag
- Department of Midwifery Science, AVAG, Amsterdam Public Health research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - M. Nieuwenhuijze
- Research Centre for Midwifery Science, Zuyd University, Universiteitssingel 60, 6229 ER Maastricht, the Netherlands
| | - T. Van den Akker
- Department of Obstetrics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - C. J. Verhoeven
- Department of Midwifery Science, AVAG, Amsterdam Public Health research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, De Run 4600, PO Box 7777, 5500 MB Veldhoven, the Netherlands
| | - C. Geerts
- Department of Midwifery Science, AVAG, Amsterdam Public Health research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - F. Schellevis
- NIVEL (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN Utrecht, the Netherlands
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - A. De Jonge
- Department of Midwifery Science, AVAG, Amsterdam Public Health research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
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11
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van Haaren-Ten Haken TM, Hendrix MJ, Nieuwenhuijze MJ, de Vries RG, Nijhuis JG. Birth place preferences and women's expectations and experiences regarding duration and pain of labor. J Psychosom Obstet Gynaecol 2018; 39:19-28. [PMID: 28165843 DOI: 10.1080/0167482x.2017.1285900] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION We know a great deal about how childbirth is affected by setting; we know less about how the experience of birth is shaped by the attitudes women bring with them to the birthing room. In order to better understand how women frame childbirth, we examined the relationship between birth place preference and expectations and experiences regarding duration of labor and labor pain in healthy nulliparous women. METHODS A prospective cohort study (2007-2011) of 454 women who preferred a home birth (n = 179), a midwife-led hospital birth (n = 133) or an obstetrician-led hospital birth (n = 142) in the Netherlands. Data were collected using three questionnaires (before 20 weeks gestation, 32 weeks gestation and 6 weeks postpartum) and medical records. Analyses were performed according to the initial preferred place of birth. RESULTS Women who preferred a home birth were significantly less likely to be worried about the duration of labor (OR 0.5, 95%CI 0.2-0.9) and were less likely to expect difficulties with coping with pain (OR 0.4, 95%CI 0.2-0.8) compared with women who preferred an obstetrician-led birth. We found no significant differences in postpartum accounts of duration of labor. When compared to women who preferred an obstetrician-led birth, women who preferred a home birth were significantly less likely to experience labor pain as unpleasant (OR 0.3, 95%CI 0.1-0.7). Women who preferred a midwife-led birth - either home or hospital - were more likely to report that it was not possible to make their own choices regarding pain relief compared to women who preferred obstetrician-led care (OR 4.3, 95%CI 1.9-9.8 resp. 3.4, 95%CI 1.5-7.7). Compared to women who preferred a midwife-led hospital birth, women who preferred a home birth had an increased likelihood of being dissatisfied about the management of pain relief (OR 2.5, 95%CI 1.1-6.0). DISCUSSION Our findings suggest a more natural orientation toward birth with the acceptance of labor pain as part of giving birth in women with a preference for a home birth. Knowledge about women's expectations and experiences will help caregivers to prepare women for childbirth and will equip them to advise women on birth settings that fit their cognitive frame.
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Affiliation(s)
| | - Marijke J Hendrix
- a Research Center for Midwifery Science Maastricht, Zuyd University , Maastricht , The Netherlands
| | - Marianne J Nieuwenhuijze
- a Research Center for Midwifery Science Maastricht, Zuyd University , Maastricht , The Netherlands
| | - Raymond G de Vries
- a Research Center for Midwifery Science Maastricht, Zuyd University , Maastricht , The Netherlands.,b CAPHRI School for Public Health and Primary Care , Maastricht University Medical Center , Maastricht , The Netherlands
| | - Jan G Nijhuis
- c Department of Obstetrics & Gynecology/GROW - School for Oncology and Developmental Biology , Maastricht University Medical Center , Maastricht , The Netherlands
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12
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Hermus M, Boesveld I, van der Pal-de Bruin K, Wiegers T. Development of the Optimality Index-NL2015, an Instrument to Measure Outcomes of Maternity Care. J Midwifery Womens Health 2017; 62:580-588. [PMID: 28950442 DOI: 10.1111/jmwh.12650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 04/20/2017] [Accepted: 05/09/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION An optimality index is a composite tool to measure maximum outcome with minimal intervention. It focuses on optimality instead of on normality and is useful in comparing differences in processes and perinatal outcomes for women at low risk of complications. The latest Dutch version dates from 2 decades ago, and international versions of the optimality index are not directly applicable to the Dutch maternity system. Most data for perinatal research in the Netherlands are derived from a national perinatal database: the Netherlands Perinatal Registry. The aim of this study was to develop a new Dutch version of the optimality index (OI-NL2015) that could be calculated from data derived from this national perinatal database and to assess the reliability of these data for use in the index. METHODS Potential items were collected by a thorough comparison of earlier (inter)national optimality indexes and the current data collection of the national database. All items were reviewed by 2 experts in maternity care and assessed for importance, relevance for the Dutch maternity care system, and feasibility to retrieve information on these items. For each item a criterion for optimality was formulated based on evidence-based or consensus-based effectiveness of care in pregnancy and childbirth. All selected items were scored on potential problems, with reliability by 20 randomly selected community midwives. The level of agreement was calculated comparing these 2 data sets, which included data of the same women. RESULTS The final OI-NL2015 consists of 31 items in 3 different components: 22 intrapartum, 7 neonatal, and 2 postpartum. Of the 7 items that were examined because of expected potential problems with reliability, in 6 items a level of 90% agreement was found. DISCUSSION An optimality index is not a standard measurement instrument but must be validated and adapted to local circumstances and available data.
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13
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Perceptions of nearly graduated fourth year midwifery students regarding a ‘good midwife’ in the Netherlands. Midwifery 2017; 50:157-162. [DOI: 10.1016/j.midw.2017.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/06/2017] [Accepted: 04/23/2017] [Indexed: 11/23/2022]
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14
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An Approach to measuring Integrated Care within a Maternity Care System: Experiences from the Maternity Care Network Study and the Dutch Birth Centre Study. Int J Integr Care 2017; 17:6. [PMID: 28970747 PMCID: PMC5624115 DOI: 10.5334/ijic.2522] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Introduction: Integrated care is considered to be a means to reduce costs, improve the quality of care and generate better patient outcomes. At present, little is known about integrated care in maternity care systems. We developed questionnaires to examine integrated care in two different settings, using the taxonomy of the Rainbow Model of Integrated Care. The aim of this study was to explore the validity of these questionnaires. Methods: We used data collected between 2013 and 2015 from two studies: the Maternity Care Network Study (634 respondents) and the Dutch Birth Centre Study (56 respondents). We assessed the feasibility, discriminative validity, and reliability of the questionnaires. Results: Both questionnaires showed good feasibility (overall missing rate < 20%) and reliability (Cronbach’s Alpha coefficient > 0.70). Between-subgroups post-hoc comparisons showed statistically significant differences on integration profiles between regional networks (on all items, dimensions of integration and total integration score) and birth centres (on 50% of the items and dimensions of integration). Discussion: Both questionnaires are feasible and can discriminate between sites with different integration profiles in The Netherlands. They offer an opportunity to better understand integrated care as one step in understanding the complexity of the concept.
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15
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van Stenus CMV, Gotink M, Boere-Boonekamp MM, Sools A, Need A. Through the client's eyes: using narratives to explore experiences of care transfers during pregnancy, childbirth, and the neonatal period. BMC Pregnancy Childbirth 2017; 17:182. [PMID: 28606067 PMCID: PMC5467260 DOI: 10.1186/s12884-017-1369-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 06/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The client experience is an important outcome in the evaluation and development of perinatal healthcare. But because clients meet different professionals, measuring such experiences poses a challenge. This is especially the case in the Netherlands, where pregnant women are often transferred between professionals due to the nation's approach to risk selection. This paper explores questions around how clients experience transfers of care during pregnancy, childbirth, and the neonatal period, as well as how these experiences compare to the established quality of care aspects the Dutch Patient Federation developed. METHOD Narratives from 17 Dutch women who had given birth about their experiences with transfers were collected in the Netherlands. The narratives, for which informed consent was obtained, were collected on paper and online. Storyline analysis was used to identify story types. Story types portray patterns that indicate how clients experience transfers between healthcare providers. A comparative analysis was performed to identify differences and similarities between existing quality criteria and those clients mentioned. RESULTS Four story types were identified: 1) Disconnected transfers of care lead to uncertainties; 2) Seamless transfers of care due to proper collaboration lead to positive experiences; 3) Transfers of care lead to disruption of patient-provider connectedness; 4) Transfer of care is initiated by the client to make pregnancy and childbirth dreams come true. Most of the quality aspects derived from these story types were identified as being similar or complementary to the Dutch Patient Federation list. A 'new' aspect identified in the clients' stories was the influencing role of prior experiences with transfers of care on current expectations, fears, and wishes. CONCLUSIONS Transfers of care affect clients greatly and influence their experiences. Good communication, seamless transfers, and maintaining autonomy contribute to more positive experiences. The stories also show that previous experiences influence client's expectations for the next pregnancy, childbirth, and transfers of care.
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Affiliation(s)
- Cherelle M V van Stenus
- Institute for Innovation and Governance Studies, Departments of Public Administration, and Health Technology and Services Research, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
| | - Mark Gotink
- Department of Youth Healthcare, GGD Twente, P.O. Box 1400, 7500 BK, Enschede, The Netherlands
| | - Magda M Boere-Boonekamp
- Institute for Innovation and Governance Studies, Department of Health Technology and Services Research, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Anneke Sools
- Institute for Innovation and Governance Studies. Department of Psychology, Health and Technology, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Ariana Need
- Institute for Innovation and Governance Studies, Department of Public Administration, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
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16
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Klomp T, Witteveen AB, de Jonge A, Hutton EK, Lagro-Janssen ALM. A qualitative interview study into experiences of management of labor pain among women in midwife-led care in the Netherlands. J Psychosom Obstet Gynaecol 2017; 38:94-102. [PMID: 27778527 DOI: 10.1080/0167482x.2016.1244522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Many pregnant women are concerned about the pain they will experience in labor and how to deal with this. This study's objective was to explore women's postpartum perception and view of how they dealt with labor pain. METHODS Semistructured postpartum interviews were analyzed using the constant comparison method. Using purposive sampling, we selected 17 women from five midwifery practices across the Netherlands, from August 2009 to September 2010. RESULTS Women reported that control over decision making during labor (about dealing with pain) helped them to deal with labor pain, as did continuous midwife support at home and in hospital, and effective childbirth preparation. Some of these women implicitly or explicitly indicated that midwives should know which method of pain management they need during labor and arrange this in good time. DISCUSSION It may be difficult for midwives to discriminate between women who need continuous support through labor without pain medication and those who genuinely desire pain medication at a certain point in labor, and who will be dissatisfied postpartum if this need is unrecognized and unfulfilled.
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Affiliation(s)
- Trudy Klomp
- a Department of Midwifery Science , AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam , the Netherlands
| | - Anke B Witteveen
- a Department of Midwifery Science , AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam , the Netherlands
| | - Ank de Jonge
- a Department of Midwifery Science , AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam , the Netherlands
| | - Eileen K Hutton
- a Department of Midwifery Science , AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam , the Netherlands.,c Midwifery Education Program , McMaster University Hamilton , Ontario , Canada
| | - Antoine L M Lagro-Janssen
- b Department of Primary Care and Community Care, Women's Studies Medicine , Radboud University Medical Center Nijmegen , the Netherlands
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17
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Koelewijn JM, Sluijs AM, Vrijkotte TGM. Possible relationship between general and pregnancy-related anxiety during the first half of pregnancy and the birth process: a prospective cohort study. BMJ Open 2017; 7:e013413. [PMID: 28490549 PMCID: PMC5623367 DOI: 10.1136/bmjopen-2016-013413] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The rate of interventions during childbirth has increased dramatically during the last decades. Maternal anxiety might play a role in the progress of the labour process and interventions during labour. This study aimed to identify associations between anxiety in the first half of pregnancy and the birth process, including any interventions required during labour. In addition, differences in the associations by parity and ethnicity were explored. DESIGN Prospective cohort study. SETTING Primary care midwifery practices and secondary/tertiary care obstetric practices in Amsterdam, participating in the multiethnic ABCD (Amsterdam Born Children and their Development) study (participation rate 96%; response 8266/12 373 (67%)). PARTICIPANTS Included were women with singletons, alive at labour start, with a gestational age ≥24 weeks (n=6443). INDEPENDENT VARIABLE General anxiety (State-Trait Anxiety Inventory state) and pregnancy-related anxiety (Pregnancy-Related Anxieties Questionnaire (PRAQ)) were self-reported in the first half of pregnancy. OUTCOMES Associations between both forms of anxiety and several indicators of the birth process were analysed. Subgroup analyses were performed for parity and ethnicity. RESULTS The prevalence of high general anxiety (State-Trait Anxiety Inventory score ≥43) and pregnancy-related anxiety (PRAQ score ≥P90) were 30.9% and 11.0%, respectively. After adjustment, in nulliparae, both general anxiety and pregnancy-related anxiety were associated with pain relief and/or sedation (OR for general anxiety 1.23; 95% CI 1.02 to 1.48; OR for pregnancy-related anxiety 1.45; 95% CI 1.14 to 1.85). In multiparae, general anxiety was associated with induction of labour (OR 1.53; 95% CI 1.16 to 2.03) and pregnancy-related anxiety was associated with primary caesarean section (OR 1.66; 95% CI 1.02 to 2.70). Associations were largely similar for all ethnicities. CONCLUSIONS High levels of general and pregnancy-related anxiety in early pregnancy contribute modestly to more interventions during the birth process with similar associations between ethnic groups, but with some differences between nulliparae and multiparae.
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Affiliation(s)
- Johanna Maria Koelewijn
- Sanquin Research and Landsteiner Laboratory, Department of Experimental Immunohematology, University of Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anne Marie Sluijs
- Department of Obstetrics and Gynecology, Leiden University Medical Center, University of Leiden, Leiden, The Netherlands
| | - Tanja G M Vrijkotte
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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18
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Offerhaus PM, de Jonge A, van der Pal-de-Bruin KM, Hukkelhoven CWPM, Scheepers PLH, Lagro-Janssen ALM. Change in primary midwife-led care in the Netherlands in 2000–2008: A descriptive study of caesarean sections and other interventions among 807,437 low-risk births. Midwifery 2016. [PMID: 26203475 DOI: 10.1016/j.midw.2015.01.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE to study whether an increase in intrapartum referrals in primary midwife-led care births in the Netherlands is accompanied by an increase in caesarean sections. DESIGN nationwide descriptive study. SETTING The Netherlands Perinatal Registry. PARTICIPANTS 807,437 births of nine year cohorts of women with low risk pregnancies in primary midwife-led care at the onset of labour between 2000 and 2008. MEASUREMENTS primary outcome is the caesarean section rate. Vaginal instrumental childbirth, augmentation with oxytocin, and pharmacological pain relief are secondary outcomes. Trends in outcomes are described. We used logistic regression to explore whether changes in the planned place of birth and other maternal characteristics were associated with the caesarean section rate. FINDINGS the caesarean section rate increased from 6.2 to 8.3 per cent for nulliparous and from 0.8 to 1.1 per cent for multiparous women. After controlling for maternal characteristics the year by year increase in the caesarean section rate was still significant for nulliparous women (adj OR 1.03; 95% CI 1.02–1.03). The vaginal instrumental birth declined from 18.2 to 17.4 per cent for nulliparous women (multiparous women: 1.7–1.5 per cent). Augmentation of labour and/or pharmacological pain relief increased from 23.1 to 38.1 per cent for nulliparous women and from 5.4 to 9.6 per cent for multiparous women. CONCLUSION the rise in augmentation of labour, pharmacological pain relief and electronic fetal monitoring in the period 2000–2008 among women in primary midwife-led care was accompanied by an increase in caesarean section rate for nulliparous women. The vaginal instrumental deliveries declined for both nulliparous and multiparous women. IMPLICATIONS FOR PRACTICE primary care midwives should evaluate whether they can strengthen the opportunities for nulliparous women to achieve a physiological birth, without augmentation or pharmacological pain relief. If such interventions are considered necessary to achieve a spontaneous vaginal birth, the current disadvantage of discontinuity of care should be reduced. In a more integrated care system, women could receive continuous care and support from their own primary care midwife, as long as only supportive interventions are needed.
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Klomp T, de Jonge A, Hutton EK, Hers S, Lagro-Janssen ALM. Perceptions of labour pain management of Dutch primary care midwives: a focus group study. BMC Pregnancy Childbirth 2016; 16:6. [PMID: 26775154 PMCID: PMC4715289 DOI: 10.1186/s12884-015-0795-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 12/31/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Labour pain is a major concern for women, their partners and maternity health care professionals. However, little is known about Dutch midwives' perceptions of working with women experiencing labour pain. The aim of this study was to explore midwives' perceptions of supporting women in dealing with pain during labour. METHODS We conducted a qualitative focus group study with four focus groups, including a total of 23 midwives from 23 midwifery practices across the country. Purposive sampling was used to select the practices. The constant comparison method of Glaser and Straus (1967, ren. 1995) was used to gain an understanding of midwives' perceptions regarding labour pain management. RESULTS We found two main themes. The first theme concerned the midwives' experienced professional role conflict, which was reflected in their approach of labour pain management along a spectrum from "working with pain" to a "pain relief" approach. The second theme identified situational factors, including time constraints; discontinuity of care; role of the partner; and various cultural influences, that altered the context in which care was provided and how midwives saw their professional role. CONCLUSION Midwives felt challenged by the need to balance their professional attitude towards normal birth and labour pain, which favours working with pain, with the shift in society towards a wider acceptance of pharmacological pain management during labour. This shift compelled them to redefine their professional identity.
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Affiliation(s)
- Trudy Klomp
- Department of Midwifery Science, AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, D4-40, 1081, BT, Amsterdam, The Netherlands.
| | - Ank de Jonge
- Department of Midwifery Science, AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, D4-40, 1081, BT, Amsterdam, The Netherlands
| | - Eileen K Hutton
- Department of Midwifery Science, AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, D4-40, 1081, BT, Amsterdam, The Netherlands
- Midwifery Education Program, McMaster University Hamilton, Hamilton, ON, Canada
| | - Suzanne Hers
- Department of Midwifery Science, AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, D4-40, 1081, BT, Amsterdam, The Netherlands
| | - Antoine L M Lagro-Janssen
- Department of Primary Care and Community Care, Women's Studies Medicine, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
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Recent Clinical Characteristics of Labors Using Three Japanese Systems of Midwife-Led Primary Delivery Care. Nurs Res Pract 2016; 2016:9101479. [PMID: 27034827 PMCID: PMC4789428 DOI: 10.1155/2016/9101479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 12/31/2015] [Accepted: 02/08/2016] [Indexed: 11/25/2022] Open
Abstract
Objective. The objective of this study was to describe the recent clinical characteristics of labor using 3 systems of Japanese midwife-led primary delivery care, as follows: (1) those intending to give birth at home managed by midwives who do not belong to our hospital, (2) those planning to give birth in our hospital managed by the same midwives, and (3) those planning to give birth managed by midwives who belong to our hospital. Methods. A retrospective cohort study was performed. Results. There were no significant differences in the obstetric or neonatal outcomes among the 3 groups. The rate of transfers during labor with the system involving midwives belonging to our hospital was higher than those with the other 2 systems. In addition, the timing of transfers in the system with the midwives belonging to our hospital was earlier than with the other 2 systems. Among the 3 groups, there were no significant differences in the rate of the main 2 indications for transfers: fetal heart rate abnormality and failure to progress. Conclusion. There were no significant differences in perinatal outcomes among the 3 systems; however, there were some differences in the status of transfers to obstetric shared care.
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Schuit E, Hukkelhoven CWPM, van der Goes BY, Overbeeke I, Moons KGM, Mol BWJ, Groenwold RHH, Kwee A. Risk indicators for referral during labor from community midwife to gynecologist: a prospective cohort study. J Matern Fetal Neonatal Med 2015; 29:3304-11. [PMID: 26600182 DOI: 10.3109/14767058.2015.1124080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To identify risk indicators for referral during labor from community midwife to a gynecologist in a prospective cohort of women with a singleton term pregnancy, starting labor with a community midwife between 2000 and 2007, registered in the Dutch national perinatal registry. MAIN OUTCOME MEASURES Referral from community midwife to a gynecologist during labor, because of fetal distress, failure to progress in second stage of labor, meconium stained amniotic fluid, failure to progress in first stage of labor, wish for pain relief, a combination of other less urgent reasons or no referral (reference). RESULTS A total of 241 595 (32%) were referred from community midwife to a gynecologist during labor, because of fetal distress (FD;5%), failure to progress in second stage of labor (FTP2;14%), meconium stained amniotic fluid (MSAF;24%), failure to progress in first stage of labor (FTP1;17%), wish for pain relief (WFPR;7%) or a combination of other less urgent reasons, for example, malpresentation (e.g. breech) or other nonspecified problems (OTHER;33%). The strongest overall risk indicators were gestational age (lower risk of referral because of FD, FTP2, MSAF, FTP1 and WFPR and a higher risk of referral because of OTHER at a gestational age between 37(+0) and 37(+)(6) weeks, and higher risks of referral for all reasons at a gestational age ≥41(+)(0) when compared to a gestational age between 38 (+)(0) and 40 (+)(6) weeks and no referral), the intended place of delivery (higher risk of all types of referral compared to no referral when the intended place of delivery was either at a midwife-led birth center or a hospital instead of at home) and birth history (higher risk of all types of referral compared to no referral when women had a history of instrumental vaginal delivery or when they were nulliparous instead of being multiparous without a history of an instrument vaginal delivery). Risk indicators associated with specific reasons of referral were maternal age, ethnicity, degree of urbanization, social economic status, neonatal gender and birth weight. CONCLUSIONS Among low-risk pregnant women, a referral during labor is associated with readily available risk indicators. These risk indicators may be used to increase referral risk awareness and to counsel women for the intended place to start labor.
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Affiliation(s)
- Ewoud Schuit
- a Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht , Utrecht , the Netherlands .,b Department of Obstetrics and Gynecology , Academic Medical Center , Amsterdam , the Netherlands .,c Stanford Prevention Research Center, Stanford University , Stanford , CA , USA
| | | | - Birgit Y van der Goes
- b Department of Obstetrics and Gynecology , Academic Medical Center , Amsterdam , the Netherlands
| | - Ilanit Overbeeke
- e Department of Obstetrics and Gynecology , University Medical Center Utrecht , Utrecht , the Netherlands
| | - Karel G M Moons
- a Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht , Utrecht , the Netherlands
| | - Ben W J Mol
- f The Robinson Institute, School of Reproductive Health and Pediatrics, University of Adelaide , Adelaide , Australia , and.,g The South Australian Health and Medical Research Institute , Adelaide , Australia
| | - Rolf H H Groenwold
- a Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht , Utrecht , the Netherlands
| | - Anneke Kwee
- e Department of Obstetrics and Gynecology , University Medical Center Utrecht , Utrecht , the Netherlands
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The Effect of Multiprofessional Simulation-Based Obstetric Team Training on Patient-Reported Quality of Care. Simul Healthc 2015. [DOI: 10.1097/sih.0000000000000099] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Hermus MAA, Wiegers TA, Hitzert MF, Boesveld IC, van den Akker-van Marle ME, Akkermans HA, Bruijnzeels MA, Franx A, de Graaf JP, Rijnders MEB, Steegers EAP, van der Pal-de Bruin KM. The Dutch Birth Centre Study: study design of a programmatic evaluation of the effect of birth centre care in the Netherlands. BMC Pregnancy Childbirth 2015; 15:148. [PMID: 26174336 PMCID: PMC4502605 DOI: 10.1186/s12884-015-0585-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 07/03/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Birth centres are regarded as settings where women with uncomplicated pregnancies can give birth, assisted by a midwife and a maternity care assistant. In case of (threatening) complications referral to a maternity unit of a hospital is necessary. In the last decade up to 20 different birth centres have been instituted in the Netherlands. This increase in birth centres is attributed to various reasons such as a safe and easy accessible place of birth, organizational efficiency in integration of care and direct access to obstetric hospital care if needed, and better use of maternity care assistance. Birth centres are assumed to offer increased integration and quality of care and thus to contribute to better perinatal and maternal outcomes. So far there is no evidence for this assumption as no previous studies of birth centres have been carried out in the Netherlands. DESIGN The aims are 1) Identification of birth centres and measuring integration of organization and care 2) Measuring the quality of birth centre care 3) Effects of introducing a birth centre on regional quality and provision of care 4) Cost-effectiveness analysis 5) In depth longitudinal analysis of the organization and processes in birth centres. Different qualitative and quantitative methods will be used in the different sub studies. The design is a multi-centre, multi-method study, including surveys, interviews, observations, and analysis of registration data and documents. DISCUSSION The results of this study will enable users of maternity care, professionals, policy makers and health care financers to make an informed choice about the kind of birth location that is appropriate for their needs and wishes.
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Affiliation(s)
- Marieke A A Hermus
- Department of Child Health, TNO, PO Box 2215, 2301 CE, Leiden, The Netherlands.
- Department of Obstetrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
- Midwifery Practice Trivia, Werkmansbeemd 2, 4907 EW, Oosterhout, The Netherlands.
| | - Therese A Wiegers
- NIVEL (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN, Utrecht, The Netherlands.
| | - Marit F Hitzert
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Inge C Boesveld
- Jan van Es Institute, Netherlands Expert Centre Integrated Primary Care, Randstad 2145-a 1314 BG, Almere, The Netherlands.
| | | | - Henk A Akkermans
- Department of Management, Tilburg School of Economics and Management, PO Box 90153, 5000 LE, Tilburg, The Netherlands.
| | - Marc A Bruijnzeels
- Jan van Es Institute, Netherlands Expert Centre Integrated Primary Care, Randstad 2145-a 1314 BG, Almere, The Netherlands.
| | - Arie Franx
- Division Woman and Baby, University Medical Centre Utrecht, PO box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Johanna P de Graaf
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | | | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Perdok H, Jans S, Verhoeven C, van Dillen J, Mol BW, de Jonge A. Intrapartum referral from primary to secondary care in the Netherlands: a retrospective cohort study on management of labor and outcomes. Birth 2015; 42:156-64. [PMID: 25846937 DOI: 10.1111/birt.12160] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/23/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND In the Dutch maternity care system, primary care midwives provide care to low-risk women and refer to obstetricians if risks or complications occur. We examined reasons for referral, management of labor, and maternal and neonatal outcomes among women who were referred during labor. METHODS In a retrospective cohort study, descriptive analyses were performed on data obtained from patient records. Six purposively chosen hospitals in The Netherlands participated in the study from June 2011 to February 2012. The study population included 600 pregnant women who were referred during labor from primary to secondary care. MAIN OUTCOME MEASURES Reasons for referral, interventions after referral, mode of delivery, and maternal and neonatal outcomes. RESULTS Of women who were referred during labor, three out of four women were referred for moderate risk indications: request for pain relief (30.5%), meconium-stained liquor (25.3%), failure to progress during first stage of labor (14.0%), and prolonged ruptured membranes without contractions (12.5%). Of all women, 65.7 percent had a spontaneous vaginal delivery and 59.7 percent received some kind of pain relief. Acute referral, meaning fetal distress, occurred in 5.5 percent. Of the newborns, 2.7 percent had an Apgar score of 7 or less after 5 minutes and 1.2 percent had an umbilical cord pH < 7.05. Postpartum complications occurred among 11.0 percent of women. CONCLUSION Women who are referred during labor have a high probability of spontaneous vaginal delivery. To improve continuity of care and satisfaction for this group of women, management of labor could be continued by trained primary care midwives.
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Affiliation(s)
- Hilde Perdok
- Department of Midwifery Science, AVAG and the EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Suze Jans
- Royal Dutch Organisation of Midwives, Utrecht, The Netherlands
| | - Corine Verhoeven
- Department of Midwifery Science, AVAG and the EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.,Maxima Medical Centre, Veldhoven, The Netherlands
| | - Jeroen van Dillen
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre Nijmegen, The Netherlands
| | - Ben Willem Mol
- Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia
| | - Ank de Jonge
- Department of Midwifery Science, AVAG and the EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
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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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Offerhaus PM, Otten W, Boxem-Tiemessen JCG, de Jonge A, van der Pal-de Bruin KM, Scheepers PLH, Lagro-Janssen ALM. Variation in intrapartum referral rates in primary midwifery care in the Netherlands: a discrete choice experiment. Midwifery 2015; 31:e69-78. [PMID: 25660846 DOI: 10.1016/j.midw.2015.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 01/09/2015] [Accepted: 01/11/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE in midwife-led care models of maternity care, midwives are responsible for intrapartum referrals to the obstetrician or obstetric unit, in order to give their clients access to secondary obstetric care. This study explores the influence of risk perception, policy on routine labour management, and other midwife related factors on intrapartum referral decisions of Dutch midwives. DESIGN a questionnaire was used, in which a referral decision was asked in 14 early labour scenarios (Discrete Choice Experiment or DCE). The scenarios varied in woman characteristics (BMI, gestational age, the preferred birth location, adequate support by a partner, language problems and coping) and in clinical labour characteristics (cervical dilatation, estimated head-to-cervix pressure, and descent of the head). SETTING primary care midwives in the Netherlands. PARTICIPANTS a systematic random selection of 243 practicing primary care midwives. The response rate was 48 per cent (117/243). MEASUREMENTS the Impact Factor of the characteristics in the DCE was calculated using a conjoint analysis. The number of intrapartum referrals to secondary obstetric care in the 14 scenarios of the DCE was calculated as the individual referral score. Risk perception was assessed by respondents׳ estimates of the probability of eight birth outcomes. The associations between midwives׳ policy on management of physiological labour, personal characteristics, workload in the practice, number of midwives in the practice, and referral score were explored. FINDINGS the estimated head-to-cervix pressure and descent of the head had the largest impact on referral decisions in the DCE. The median referral score was five (range 0-14). Estimates of probability on birth outcomes were predominantly overestimating actual risks. Factors significantly associated with a high referral score were: a low estimated probability of a spontaneous vaginal birth (p=0.007), adhering to the active management policy Proactive Support of Labour (PSOL) (p=0.047), and a practice situated in a rural area or small city (p=0.016). KEY CONCLUSIONS there is considerable variation in referral decisions among midwives that cannot be explained by woman characteristics or clinical factors in early labour. A realistic perception of the possibility of a spontaneous vaginal birth and adhering to expectant management can contribute to the prevention of unwarranted medicalisation of physiological childbirth. IMPLICATIONS FOR PRACTICE awareness of variation in referrals and the associated midwife-related factors can stimulate midwives to reflect on their referral behavior. To diminish unwarranted variation, high quality research on the optimal management of a physiological first stage of labour should be performed.
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Affiliation(s)
- Pien M Offerhaus
- KNOV (Royal Dutch Organisation for Midwives), P.O. Box 2001, 3500GA Utrecht, The Netherlands.
| | - Wilma Otten
- TNO Life Style, P.O. Box 2215, 2301 CE Leiden, The Netherlands.
| | | | - Ank de Jonge
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
| | | | - Peer L H Scheepers
- Faculty of Social Sciences, Radboud University, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands.
| | - Antoine L M Lagro-Janssen
- Radboud University Nijmegen Medical Centre, Internal Postal Code 118, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
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Rosman S. Down syndrome screening information in midwifery practices in the Netherlands: Strategies to integrate biomedical information. Health (London) 2014; 20:94-109. [PMID: 25504473 DOI: 10.1177/1363459314561695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this qualitative study was to analyse counselling with regard to prenatal screening in midwifery consultations in the Netherlands where a national prenatal screening programme has only existed since 2007, after years of social and political debates. The methodology is based on in situ observations of 25 counselling consultations in four midwifery practices in two main cities in the Netherlands. The results of this study show that, since midwives are obliged to offer information on Down syndrome screening to all pregnant women (2007), they have to deal with the communication of medical screening information using biostatistical concepts to explain risks, calculations, probabilities and chromosomal anomalies. In order to avoid the risk of medicalization of their consultation, midwives develop strategies that allow them to integrate this new biomedical discourse while maintaining their low medicalized approach of midwife-led care. One of their main strategies is to switch from 'alarming' biomedical messages to 'reassuring words' in order to manage the anxiety induced by the information and to keep the control over their low medicalized consultation. They also tend to distance themselves from the obligation to talk about screening. The way midwives handle these counselling consultations allows them to respect their obligation to propose information, and to remain faithful to their struggle to protect the natural process of pregnancy as well as their professional autonomy.
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Perdok H, Mokkink L, van Dillen J, Westerneng M, Jans S, Mol BW, de Jonge A. Opinions of maternity care professionals about integration of care during labor for "moderate risk" indications: a Delphi study in the Netherlands. Birth 2014; 41:195-205. [PMID: 24702519 DOI: 10.1111/birt.12102] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/01/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The percentage of referrals during labor from primary midwife-led care to obstetrician-led care has increased over the past years in The Netherlands. Most women are referred for indications with a moderate increase in risk and are looked after by clinical midwives. This study aims to provide insight into the opinions of maternity care professionals about integration of care and involvement of primary care midwives in the intrapartum care of women with "moderate risk" factors. METHODS A Delphi study consisting of three rounds was conducted. A purposively selected heterogenic panel of 50 professionals, including obstetricians, primary care midwives, clinical midwives, and obstetric nurses, answered questions anonymously. RESULTS Although primary care midwives would like to expand their responsibilities and tasks with respect to "moderate risk" indications, consensus among panel members was only reached concerning prolonged rupture of membranes for which the primary care midwife could remain the caregiver. CONCLUSION This study shows that most participants support more integration of care during labor. The lack of consensus among Dutch maternity care professionals with regard to the distribution of responsibilities and tasks for "moderate risk" indications is a challenge. Further studies should explore how to deal with differences in opinions among professionals when integrating maternity care systems.
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Affiliation(s)
- Hilde Perdok
- Department of Midwifery Science, AVAG and the EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
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van Haaren-ten Haken T, Pavlova M, Hendrix M, Nieuwenhuijze M, de Vries R, Nijhuis J. Eliciting preferences for key attributes of intrapartum care in the Netherlands. Birth 2014; 41:185-94. [PMID: 24702440 DOI: 10.1111/birt.12081] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND As part of the move toward "patient-centered care," women's preferences with regard to maternity services have become increasingly important to policy makers. To realize optimal patient-centered care, knowledge of patients' preferences is essential. The aim of our study was to assess the strength and relative importance of women's preferences for different aspects of intrapartum care in The Netherlands, where women have easy access to both home and hospital birth. METHODS A discrete choice experiment was conducted at 16 weeks of gestation as part of a Dutch multicenter, prospective cohort study from 2007 to 2011 of low-risk, nulliparous women. Responses were analyzed per intended place of birth group: midwifery-led home (n = 191) and hospital birth (n = 152) and obstetric-led hospital birth (n = 188). RESULTS We analyzed 562 questionnaires. Women in all groups preferred the possibility of influencing decision making and pain-relief treatment during birth and no co-payment for childbirth. Women with an intended home birth preferred a home-like birth setting with the assistance of a midwife and transport during birth in case of complications. Type of birth setting and transport during birth were not considered important to women with an intended midwifery- or obstetric-led hospital birth. CONCLUSION Policies aimed at the improvement of maternity care must take into account women's preferences for the possibility of pain-relief treatment and the fact that all women desire a high level of involvement in decision making. Furthermore, efforts to change maternity care systems must consider how to counter the culturally embedded nature of women's preferences.
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Affiliation(s)
- Tamar van Haaren-ten Haken
- Department midwifery science of Midwifery Education & Studies Maastricht-ZUYD, Maastricht, The Netherlands
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Offerhaus PM, de Jonge A, van der Pal–de Bruin KM, Hukkelhoven CW, Scheepers PL, Lagro-Janssen AL. Change in primary midwife-led care in the Netherlands in 2000–2008: A descriptive study of caesarean sections and other interventions among 789,795 low risk births. Midwifery 2014; 30:560-6. [DOI: 10.1016/j.midw.2013.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 06/05/2013] [Accepted: 06/13/2013] [Indexed: 10/26/2022]
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Suzuki S. Trend analysis of primary midwife-led delivery care at a Japanese perinatal center. Int J Med Sci 2014; 11:466-70. [PMID: 24688310 PMCID: PMC3970099 DOI: 10.7150/ijms.8204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 02/27/2014] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To perform trend analysis of primary midwife-led delivery care for 'low risk' pregnant women at our hospital. METHODS A retrospective cohort study was performed to examine trends and outcomes of labor under primary midwife-led delivery care at the Japanese Red Cross Katsushika Maternity Hospital between 2008 and 2012. RESULTS During the study period, the rate of deliveries initially considered 'low risk' decreased from 25 to 22% (p < 0.01). This change was associated with increased cases of previous Cesarean deliveries and preterm delivery. There were no significant changes in the neonatal outcomes; however, the rate of Cesarean delivery and incidence of severe perineal laceration in primary midwife-led delivery care were decreased from 2.1 and 3.3% to 0.3 (p = 0.02) and 1.1% (p = 0.04), respectively due to the close cooperation between midwives and obstetricians. CONCLUSION The rate of deliveries initially considered 'low risk' decreased over the last 5-year period. Closer cooperation between midwives and obstetricians is important in primary midwife-led delivery care.
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Affiliation(s)
- Shunji Suzuki
- Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital, Tokyo, Japan
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Offerhaus PM, Hukkelhoven CWPM, de Jonge A, van der Pal-de Bruin KM, Scheepers PLH, Lagro-Janssen ALM. Persisting rise in referrals during labor in primary midwife-led care in the Netherlands. Birth 2013; 40:192-201. [PMID: 24635504 DOI: 10.1111/birt.12055] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/09/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND There are concerns about the Dutch maternity care system, characterized by a strict role division between primary and secondary care. The objective of this study was to describe trends in referrals and in perinatal outcomes among labors that started in primary midwife-led care. METHODS We performed a descriptive study of all 789,795 labors that started in primary midwife-led care during 2000 to 2008 in The Netherlands. Referrals to obstetrician-led care or pediatrician were classified as urgent or nonurgent. Perinatal safety was described by perinatal mortality (intrapartum or neonatal 0-7 days), admission to neonatal intensive care unit 0-7 days, and Apgar score < 7 at 5 minutes. RESULTS The proportion of referrals during labor or after birth declined from 52.6 to 42.6 percent for nulliparous women and from 83.2 to 76.7 percent for multiparous women. Especially nonurgent referrals during the first stage increased, for nulliparous women from 28.7 to 40.7 percent and for multiparous women from 10.5 to 16.5 percent. Referrals were less frequent in planned home births. Perinatal mortality was 0.9 per thousand births for nulliparous women, and 0.6 per thousand for multiparous women. A low Apgar score was registered in 8.6 per thousand births for nulliparous women, and 4.1 per thousand for multiparous women. CONCLUSIONS There was a considerable rise in nonurgent referrals to obstetrician-led care in primary midwife-led care during labor. Perinatal safety did not improve significantly over time. The persisting rise in referrals challenges the sustainability of the current strict role division between primary and secondary maternity care in The Netherlands.
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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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Hiraizumi Y, Suzuki S. Perinatal outcomes of low-risk planned home and hospital births under midwife-led care in Japan. J Obstet Gynaecol Res 2013; 39:1500-4. [PMID: 23855717 DOI: 10.1111/jog.12094] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 02/01/2013] [Indexed: 11/27/2022]
Abstract
AIM It has not been extensively studied whether planned home and planned hospital births under primary midwife-led care increase risk of adverse events among low-risk women in Japan. METHODS A retrospective cohort study was performed to compare perinatal outcome between 291 women who were given primary midwife-led care during labor and 217 women who were given standard obstetric shared care. Among 291 women with primary midwife-led care, 168 and 123 chose home deliver and hospital delivery, respectively. Perinatal outcomes included length of labor of 24 h or more, augmentation of labor pains, delivery mode, severe perineal laceration, postpartum hemorrhage of 1000 mL or more, maternal fever of 38°C or more and neonatal asphyxia (Apgar score, <7). Analysis was by intention to treat. RESULTS The incidence of transfer from primary midwife-led care to obstetric shared care was 27% (77 women) mainly due to failure of labor progress (21%, 16 women), postpartum hemorrhage (19%, 15 women) and non-reassuring fetal status (19%, 15 women). Significantly higher incidence of transfer to obstetric shared care from primary midwife-led care was seen among women who chose hospital delivery compared with women who chose home delivery (34 vs 21%, P = 0.011). There were no significant differences in the incidence of adverse perinatal outcomes between women with obstetric shared care and women with primary midwife-led care (regardless of being hospital delivery or home delivery). CONCLUSION Approximately one-quarter of low-risk women with primary midwife-led care required obstetric care during labor or postpartum. However, primary midwife-led care during labor at home and hospital for low-risk pregnant women was not associated with adverse perinatal outcomes in Japan.
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Affiliation(s)
- Yoshie Hiraizumi
- Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital
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Klomp T, Manniën J, de Jonge A, Hutton EK, Lagro-Janssen ALM. What do midwives need to know about approaches of women towards labour pain management? A qualitative interview study into expectations of management of labour pain for pregnant women receiving midwife-led care in the Netherlands. Midwifery 2013; 30:432-8. [PMID: 23790961 DOI: 10.1016/j.midw.2013.04.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 04/11/2013] [Accepted: 04/28/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE to investigate factors important to women receiving midwife-led care with regard to their expectations for management of labour pain. DESIGN semi-structured ante partum interviews and analyses using constant comparison method. PARTICIPANTS fifteen pregnant women between 36 and 40 weeks gestation receiving midwife-led care. SETTING five midwifery practices across the Netherlands between June 2009 and July 2010. MAIN OUTCOME women's expectations regarding management of labour pain. RESULTS we found three major themes to be important in women's expectations for management of labour pain: preparation, support and control and decision-making. In regards to all these themes, three distinct approaches towards women's planning for pain management in labour were identified: the 'pragmatic natural', the 'deliberately uninformed' and the 'planned pain relief' approach. CONCLUSION midwives need to recognise that women take different approaches to pain management in labour in order to adapt care to the individual woman.
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Affiliation(s)
- Trudy Klomp
- Department of Midwifery Science, AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, D4-40, 1081 BT Amsterdam, the Netherlands.
| | - Judith Manniën
- Department of Midwifery Science, AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, D4-40, 1081 BT Amsterdam, the Netherlands
| | - Ank de Jonge
- Department of Midwifery Science, AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, D4-40, 1081 BT Amsterdam, the Netherlands
| | - Eileen K Hutton
- Department of Midwifery Science, AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, D4-40, 1081 BT Amsterdam, the Netherlands; Midwifery Education Program, McMaster University Hamilton, Ontario, Canada
| | - Antoine L M Lagro-Janssen
- Department of Primary Care and Community Care, Women's Studies Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
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Chervenak FA, McCullough LB, Brent RL, Levene MI, Arabin B. Planned home birth: the professional responsibility response. Am J Obstet Gynecol 2013; 208:31-8. [PMID: 23151491 DOI: 10.1016/j.ajog.2012.10.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 09/11/2012] [Accepted: 10/02/2012] [Indexed: 11/27/2022]
Abstract
This article addresses the recrudescence of and new support for midwife-supervised planned home birth in the United States and the other developed countries in the context of professional responsibility. Advocates of planned home birth have emphasized patient safety, patient satisfaction, cost effectiveness, and respect for women's rights. We provide a critical evaluation of each of these claims and identify professionally appropriate responses of obstetricians and other concerned physicians to planned home birth. We start with patient safety and show that planned home birth has unnecessary, preventable, irremediable increased risk of harm for pregnant, fetal, and neonatal patients. We document that the persistently high rates of emergency transport undermines patient safety and satisfaction, the raison d'etre of planned home birth, and that a comprehensive analysis undermines claims about the cost-effectiveness of planned home birth. We then argue that obstetricians and other concerned physicians should understand, identify, and correct the root causes of the recrudescence of planned home birth; respond to expressions of interest in planned home birth by women with evidence-based recommendations against it; refuse to participate in planned home birth; but still provide excellent and compassionate emergency obstetric care to women transported from planned home birth. We explain why obstetricians should not participate in or refer to randomized clinical trials of planned home vs planned hospital birth. We call on obstetricians, other concerned physicians, midwives and other obstetric providers, and their professional associations not to support planned home birth when there are safe and compassionate hospital-based alternatives and to advocate for a safe home-birth-like experience in the hospital.
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Affiliation(s)
- Frank A Chervenak
- Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY, USA
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Christiaens W, Nieuwenhuijze MJ, de Vries R. Trends in the medicalisation of childbirth in Flanders and the Netherlands. Midwifery 2012; 29:e1-8. [PMID: 23266221 DOI: 10.1016/j.midw.2012.08.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 06/20/2012] [Accepted: 08/20/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE in this paper we offer new insights about the medicalisation of childbirth by closely examining the trends in obstetric intervention rates in Flanders and the Netherlands and by considering the influence of contextual factors - including the organisation of the medical system, professional guidelines, and cultural ideas - on the way maternity care is delivered. DESIGN a comparative study using perinatal statistics from the National Perinatal Databases of the Netherlands and Flanders and historical and qualitative data about the organisation and culture of maternity care in each country. SETTING AND PARTICIPANTS in the Netherlands data are gathered from practices of the participating midwives, general practitioners and obstetricians. In Flanders the registration of data takes place in Flemish maternity units and independent midwifery practices. MEASUREMENTS AND FINDINGS in the Netherlands the home birth rate is still by far the highest in Europe and some interventions (e.g. caesarean section and epidural) are among the lowest. However, some perinatal statistics - such as in the use of epidural analgesia during labour - suggest an increasingly medical approach to birth in the Netherlands. Other trends in the Netherlands include an increasing use of inductions and augmentation in labour, and a decreasing number of births in primary care. The practice of home birth is being challenged by critical discussions in the popular media and 'scientific' debates among professionals. In Flanders, there have been some efforts to reduce medicalisation of childbirth, focussed on specific interventions such as induction and episiotomy. KEY CONCLUSIONS in recent years the obstetric intervention rates in Belgium and the Netherlands are slowly converging. IMPLICATIONS FOR PRACTICE because the lives of women, midwives, and obstetricians (among others) are significantly affected by patterns of medicalisation and de-medicalisation, it is important that we understand the drivers of the medicalising process.
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Affiliation(s)
- Wendy Christiaens
- Department of Sociology, Ghent University, Korte Meer 5, 9000 Ghent, Belgium.
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McIntyre MJ. Safety of non-medically led primary maternity care models: a critical review of the international literature. AUST HEALTH REV 2012; 36:140-7. [PMID: 22624633 DOI: 10.1071/ah11039] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 08/16/2011] [Indexed: 11/23/2022]
Abstract
The Australian government has announced major reforms with the move to a primary maternity care model. The direction of the reforms remains contentious; with the Australian Medical Association warning that the introduction of non-medically led services will compromise current high standards in maternity services and threaten the safety of mothers and babies. The purpose of this paper is to conduct a critical review of the literature to determine whether there is convincing evidence to support the safety of non-medically led models of primary maternity care. Twenty-two non-randomised international studies were included representing midwifery-led care, birth centre care and home birth. Comparative outcome measurements included: perinatal mortality; perinatal morbidity; rates of medical intervention in labour; and antenatal and intrapartum referral and transfer rates. Findings support those of the three Cochrane reviews, that there is sufficient international evidence to support the conclusion of no difference in outcomes associated with low risk women in midwifery-led, birth centre and home birth models compared with standard hospital or obstetric care. These findings are limited to services involving qualified midwives working within rigorous exclusion, assessment and referral guidelines, limiting the number of urgent intrapartum transfers that come with increased risk of perinatal mortality.
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Affiliation(s)
- Meredith J McIntyre
- School of Nursing and Midwifery, Monash University, Peninsula Campus, McMahons Road, Frankston, VIC 3199, Australia.
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de Bruin-Kooistra M, Amelink-Verburg MP, Buitendijk SE, Westert GP. Finding the right indicators for assessing quality midwifery care. Int J Qual Health Care 2012; 24:301-10. [PMID: 22457241 DOI: 10.1093/intqhc/mzs006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To identify a set of indicators for monitoring the quality of maternity care for low-risk women provided by primary care midwives and general practitioners (GPs) in the Netherlands. DESIGN A Project Group (midwives, GPs, policymakers and researchers) defined a long list of potential indicators based on the literature, national guidelines and expert opinion. This list was assessed against the AIRE (Appraisal of Indicators through Research and Evaluation) instrument criteria, resulting in a short list of draft indicators. In a two-round Delphi survey, a multidisciplinary group of stakeholders reviewed the elaborated draft indicators, rating both the relationship between indicator and quality of care and the feasibility. SETTING AND PARTICIPANTS A multidisciplinary expert panel consisting of 28 midwives, 2 GPs, 3 obstetricians and 3 maternity assistants, randomly selected from different regions in the Netherlands. INTERVENTION None. MAIN OUTCOME MEASURE Set of quality indicators for midwifery care. RESULTS The Project Group generated a list of 115 potential indicators which was reduced to 35 using the AIRE criteria. The 35 draft indicators were discussed by a Delphi panel. In total, 26 indicators were recommended by the participants as relevant indicators of midwifery care, representing several levels of measurement. Eight structure indicators, 12 process indicators and 6 outcome indicators were addressing the various phases of midwifery care. CONCLUSIONS We identified a set of quality indicators concerning midwifery care provision in a low-risk population. Practicing maternity care providers adopted the large majority (83%) of the draft indicators proposed as a feasible set of indicators, describing the structure, process and outcome. The input from multidisciplinary experts in the process of identifying the right indicators showed to be essential in all phases of development.
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Affiliation(s)
- Mieneke de Bruin-Kooistra
- Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
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Lichtenbelt KD, Alizadeh BZ, Scheffer PG, Stoutenbeek P, Schielen PCJI, Page-Christiaens LCML, Schuring-Blom GH. Trends in the utilization of invasive prenatal diagnosis in The Netherlands during 2000-2009. Prenat Diagn 2011; 31:765-72. [PMID: 21692084 DOI: 10.1002/pd.2764] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 03/22/2011] [Accepted: 03/24/2011] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To analyze trends in the number and type of invasive procedure, reasons for referral, maternal age and chromosomal abnormalities over a 10-year period and correlate the trends to changes in the national prenatal screening policy. METHODS Data from 10 706 invasive prenatal procedures yielding a full karyotype, performed between 2000 and 2009 were extracted from the cytogenetic database in the central region of The Netherlands. Trends were analyzed. RESULTS Over a 10-year period, the number of invasive procedures halved and the percentage of chromosomal abnormalities detected, increased from 5.5 to 9.4%. After 2007, however, 5.7% of karyotypes in women over 36 years were found to be abnormal, versus 18.1% in women below 36 years. In 2009, 71.5% of women over 36 are still referred for invasive prenatal diagnosis on the indication advanced maternal age. CONCLUSIONS Changes in prenatal screening policy significantly increased referral after screening and improved the efficacy of invasive prenatal diagnosis. We show the continuing effect of the different policies applied in the past to women below and above the age of 36. To further improve efficacy of invasive prenatal diagnosis, first trimester combination screening should be actively offered to women of all ages.
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Affiliation(s)
- Klaske D Lichtenbelt
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands.
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Hans JD, Kimberly C. An Educational Intervention to Change Planned Behavior Concerning Midwife‐Assisted Out‐of‐Hospital Childbirth. J Midwifery Womens Health 2011; 56:371-375. [DOI: 10.1111/j.1542-2011.2011.00036.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Suzuki S, Hiraizumi Y, Satomi M, Miyake H. Midwife-led care unit for ‘low risk’ pregnant women in a Japanese hospital. J Matern Fetal Neonatal Med 2011; 24:1046-50. [DOI: 10.3109/14767058.2010.545912] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lazić Z, Takač I. Outcomes and risk factors for unplanned delivery at home and before arrival to the hospital. Wien Klin Wochenschr 2010; 123:11-4. [PMID: 21165703 DOI: 10.1007/s00508-010-1505-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2008] [Accepted: 11/10/2010] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The aim of this study was to analyze the outcomes and risk factors for unplanned delivery at home and before arrival to the hospital in Maribor region, Slovenia. METHODS We used data from medical records of all deliveries in Maribor region from the year 1997 to the year 2005. We analysed a total of 17,846 births from annual reports of the Maribor University Hospital. RESULTS Among the total of 17,846 births, there were 58 (3.2‰) unplanned births at home and on the way to the hospital. The study based on the data from medical records on safety of unplanned home birth reveals that hospital delivery is approximately 7 times safer than unplanned home delivery. This conclusion is reached by comparing perinatal mortality, which was 68‰ for unplanned deliveries at home versus 8.8‰ for deliveries at hospital. The prematurity was more common in unplanned home deliveries: 13 (22%) versus 1399 (8%) for hospital deliveries. Unplanned deliveries at home and on the way to the hospital were more common in multiparous women (ratio 4:1 compared to 1:1 for hospital births). When for all hospital deliveries the pregnancies were followed, for one third of unplanned deliveries at home or on the way to the hospital the pregnancies were not monitored. Mothers who gave birth at home or on the way to the hospital were without higher education (i.e. 55.2%) and mothers who gave birth in hospital were with higher education (i.e. 87.4%). CONCLUSIONS There was higher rate of perinatal morbidity for unplanned home deliveries compared to hospital deliveries. Factors that make unplanned home deliveries more common are high parity, absence or inadequacy of antenatal care, marital status and lower education. Some conditions in newborn, such as hypothermia, were clearly the result of unplanned birth at home. Additional effort to improve antenatal care and also identifying social vulnerabilities would possibly decrease the number of unplanned deliveries and improve the perinatal outcomes.
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Affiliation(s)
- Zlatko Lazić
- University Department of Gynecology and Perinatology, University Clinical Centre Maribor, Ljubljanska Maribor, Slovenia.
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Amelink-Verburg MP, Buitendijk SE. Pregnancy and labour in the Dutch maternity care system: what is normal? The role division between midwives and obstetricians. J Midwifery Womens Health 2010; 55:216-25. [PMID: 20434081 DOI: 10.1016/j.jmwh.2010.01.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 01/02/2010] [Accepted: 01/02/2010] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In the Dutch maternity care system, the role division between independently practising midwives (who take care of normal pregnancy and childbirth) and obstetricians (who care for pathologic pregnancy and childbirth) has been established in the so-called "List of Obstetric Indications"(LOI). The LOI designates the most appropriate care provider for women with defined medical or obstetric conditions. METHODS This descriptive study analysed the evolution of the concept of "normality" by comparing the development and the contents of the consecutive versions of the LOI from 1958 onwards. The results were related to data from available Dutch national databases concerning maternity care. RESULTS The number of conditions defined in the successive lists increased from 39 in 1958 to 143 in 2003. In the course of time, the nature and the content of many indications changed, as did the assignment to the most appropriate care provider. The basic assumptions of the Dutch maternity care system remained stable: the conviction that pregnancy and childbirth fundamentally are physiologic processes, the strong position of the independently practising midwife, and the choice between home or hospital birth for low-risk women. Nevertheless, the odds of the obstetrician being involved in the birth process increased from 24.7% in 1964 to 59.4% in 2002, whereas the role of the primary care provider decreased correspondingly. DISCUSSION Multidisciplinary research is urgently needed to better determine the risk status and the optimal type of care and care provider for each individual woman in her specific situation, taking into account the risk of both under- and over-treatment. Safely keeping women in primary care could be considered one of a midwife's interventions, just as a referral to secondary care may be. The art of midwifery and risk selection is to balance both interventions, in order to end up with the optimal result for mother and child.
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Abstract
BACKGROUND Childbirth has changed dramatically over the past 40 years, although antenatal education (AE) has not. This education has been shown to be beneficial in some countries but not in others. OBJECTIVE The objective of this study was to assess the benefits of AE during the childbirth process, controlling for the possible confounding effects of other variables and involving a comprehensive assessment of the birth process. METHOD A prospective observational study was conducted in Bizkaia, Spain, to follow 616 low-risk pregnant nulliparous women aged 18-42 years until childbirth. Women who had attended different numbers of AE sessions were compared in terms of the following: whether they arrived at hospital in established labor, whether they received epidural anesthesia before the active phase of the birth, length of the first and second stages (i.e., dilation and delivery), anxiety (Hospital Anxiety and Depression Scale), type of birth, perineal injury, satisfaction with the experience, and the 5-minute Apgar score. Results were adjusted by age, nationality, educational level, social class, personality, and the hospital where the birth occurred. RESULTS Spanish women who had attended AE classes experienced less anxiety during birth than those who had not (Hospital Anxiety and Depression Scale score adjusted difference = -1.5, 95% confidence interval = -0.1 to -3.0), whereas the opposite was found for immigrant women (adjusted difference = 2.4; 95% confidence interval = -0.6 to 5.4; AE x Nationality interaction, p = .02). No dose-response relationship was found between AE and anxiety, and no benefits were seen for the other variables. DISCUSSION Antenatal education is not found to be associated with benefits during childbirth. Subsequent research should be focused on redesigning and assessing AE in light of the current needs of women.
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Abstract
In 2008, 84% (459) of 548 women with pregnancies initially considered "low risk" requested to give birth under midwifery care at Japanese Red Cross Katsushika Maternity Hospital. Of these, 42% (191) were referred to obstetric care during labor at term; however, we found no evidence that midwifery primary obstetric care is less safe for women with "low-risk" pregnancy than is standard obstetric care. Therefore, we recommend that midwifery care be promoted with an international collaborative effort.
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Affiliation(s)
- Shunji Suzuki
- Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital, Tokyo, Japan.
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van Weel C, van der Velden K, Lagro-Janssen T. Home births revisited: the continuing search for better evidence. BJOG 2009; 116:1149-50. [DOI: 10.1111/j.1471-0528.2009.02210.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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