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de Vries P, Deneux-Tharaux C, Caram-Deelder C, Goffinet F, Henriquez D, Seco A, van der Bom J, van den Akker T. Severe postpartum hemorrhage and the risk of adverse maternal outcome: A comparative analysis of two population-based studies in France and the Netherlands. Prev Med Rep 2024; 40:102665. [PMID: 38435415 PMCID: PMC10907197 DOI: 10.1016/j.pmedr.2024.102665] [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: 11/26/2023] [Revised: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 03/05/2024] Open
Abstract
Objectives Among women with severe PPH (sPPH) in France and the Netherlands, we compared incidence of adverse maternal outcome (major obstetric hemorrhage (≥2.5L blood loss) and/or hysterectomy and/or mortality) by mode of delivery. Second, we compared use and timing of resuscitation and transfusion management, second-line uterotonics and uterine-sparing interventions (intra-uterine tamponade, compression sutures, vascular ligation, arterial embolization) by mode of delivery. Methods Secondary analysis of two population-based studies of women with sPPH in France and the Netherlands. Women were selected by a harmonized definition for sPPH: (total blood loss ≥ 1500 ml) AND (blood transfusion of ≥ 4 units packed red blood cells and/or multicomponent blood transfusion). Findings Incidence of adverse maternal outcome after vaginal birth was 793/1002, 9.1 % in the Netherlands versus 88/214, 41.1 % in France and 259/342, 76.2% versus 160/270, 59.3% after cesarean. Hemostatic agents such as fibrinogen were administered less frequently (p < 0.001) in the Netherlands (vaginal birth: 83/1002, 8.3% versus 105/2014, 49.5% in France; cesarean: 47/342, 13.7% and 152/270, 55.6%). Second-line uterotonics were started significantly later after PPH-onset in the Netherlands than France (vaginal birth: 46 versus 25 min; cesarean: 45 versus 18 min). Uterine-sparing interventions were less frequently (p < 0.001) applied in the Netherlands after vaginal birth (394/1002,39.3 %, 134/214, 62.6%) and cesarean (133/342, 38.9 % and 155/270, 57.4%), all initiated later after onset of refractory PPH in the Netherlands. Interpretation Incidence of adverse maternal outcome was higher among women with sPPH in the Netherlands than France regardless mode of birth. Possible explanatory mechanisms are earlier and more frequent use of second-line uterotonics and uterine-sparing interventions in France compared to the Netherlands.
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Affiliation(s)
- P.L.M. de Vries
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
- Port-Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - C. Deneux-Tharaux
- Université Paris Cité, Inserm, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), CRESS UMR 1153, Paris, France
| | - C. Caram-Deelder
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - F. Goffinet
- Port-Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, Inserm, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), CRESS UMR 1153, Paris, France
| | - D.D.C.A. Henriquez
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - A. Seco
- Clinical Research Unit Necker Cochin, APHP, Paris, France
| | - J.G. van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - T. van den Akker
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
- Athena Institute, VU University, Amsterdam, The Netherlands
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Simmelink R, Moll E, Verhoeven C. The influence of the attending midwife on the occurrence of episiotomy: A retrospective cohort study. Midwifery 2023; 125:103773. [PMID: 37453396 DOI: 10.1016/j.midw.2023.103773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 05/23/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Episiotomy at the time of vaginal birth can result in short- and long-term complications for women. Therefore, it is important to study factors that influence the occurrence of episiotomy. AIM To examine to what extent the individual factors of clinical midwives in the same working conditions contribute to variations in episiotomy. METHODS A retrospective cohort study was performed at a secondary care hospital in Amsterdam, the Netherlands, using data from women who were assisted by a clinical midwife during birth in 2016. The clinical midwives filled out a questionnaire to determine individual factors. The predictive value of the individual factors of the clinical midwives was examined in a multiple logistic regression model on episiotomy. RESULTS A total of 1302 births attended by 27 midwives were included. The mean episiotomy rate was 12.7%, with a range from 3.2% to 30.8% among midwives (p = 0.001). When stratified for parity, within the primipara group there was a significant variation in episiotomy among midwives with a range from 7.9% to 47.8% (p = 0.006). No significant variation was found in the occurrence of third/fourth degree tears or intact perineum. There was a significant difference in episiotomy for maternal indication among midwives (p = 0.041). Predictors for an episiotomy were number of years since graduation and place of bachelor education of the clinical midwife. CONCLUSION This study shows that individual factors of clinical midwives influence the rate of episiotomy. Predictors for an episiotomy were the number of years since graduation and place of bachelor education. This shows that continuous training of clinical midwives could contribute to reducing the number of unnecessary episiotomies. Since suspected fetal distress is the only evidence based indication to perform an episiotomy, there is room for improvement given the variation in the number of episiotomies performed for maternal indication.
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Affiliation(s)
- Renate Simmelink
- Amsterdam UMC location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, the Netherlands; Department of Obstetrics and Gynaecology, OLVG-West Hospital, Jan Tooropstraat 164, Amsterdam, the Netherlands.
| | - Etelka Moll
- Department of Obstetrics and Gynaecology, OLVG-West Hospital, Jan Tooropstraat 164, Amsterdam, the Netherlands
| | - Corine Verhoeven
- Amsterdam UMC location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, the Netherlands; Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham NG7 2RD, United Kingdom; Department of Obstetrics and Gynaecology, Maxima Medical Centre, De Run 4600, Veldhoven, the Netherlands
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Schonewille NN, Terpstra PA, van den Heuvel MEN, Van Pampus MG, van den Heuvel OA, Broekman BFP. Neonatal admission after lithium use in pregnant women with bipolar disorders: a retrospective cohort study. Int J Bipolar Disord 2023; 11:24. [PMID: 37450192 PMCID: PMC10348961 DOI: 10.1186/s40345-023-00306-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Lithium is the preferred treatment for pregnant women with bipolar disorders (BD), as it is most effective in preventing postpartum relapse. Although it has been prescribed during pregnancy for decades, the safety for neonates and obstetric outcomes are a topic of ongoing scientific debate as previous research has yielded contradicting outcomes. Our study aims to compare (re)admission rates and reasons for admissions in neonates born to women with bipolar disorders (BD) with and without lithium exposure. METHODS A retrospective observational cohort study was conducted in a Dutch secondary hospital (two locations in Amsterdam). Women with BD who gave birth after a singleton pregnancy between January 2011 and March 2021 and their neonates were included. Outcomes were obtained by medical chart review of mothers and neonates and compared between neonates with and without lithium exposure. The primary outcome was admission to a neonatal ward with monitoring, preterm birth, small for gestational age (SGA), 5-minute Apgar scores, neonatal asphyxia, and readmission ≤ 28 days. RESULTS We included 93 women with BD, who gave birth to 117 live-born neonates: 42 (36%) exposed and 75 (64%) non-exposed to lithium. There were no significant differences in neonatal admission with monitoring (16.7 vs. 20.0%, p = 0.844). Additionally, preterm birth (7.1 vs. 5.3%), SGA (0.0 vs. 8.0%), 5-minute Apgar scores (means 9.50 vs. 9.51), neonatal asphyxia (4.8 vs. 2.7%) and readmission (4.8 vs. 5.3%) were comparable. Overall, 18.8% of BD offspring was admitted. Women with BD had high rates of caesarean section (29.1%), gestational diabetes (12.8%) and hypertensive disorders of pregnancy (8.5%). CONCLUSIONS In a sample of neonates all born to women with BD using various other psychotropic drugs, exposure to lithium was not associated with greater risk of neonatal admission to a ward with monitoring compared to non-exposure to lithium, questioning the necessity for special measures after lithium exposure. However, offspring of women with BD was admitted regularly and women with BD have high obstetric risk which require clinical and scientific attention.
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Affiliation(s)
- Noralie N Schonewille
- Department of Psychiatry and Medical Psychology, OLVG, Oosterpark 9, Amsterdam, The Netherlands.
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Amsterdam Public Health Program, Amsterdam, The Netherlands.
| | - Pleun A Terpstra
- Department of Psychiatry and Medical Psychology, OLVG, Oosterpark 9, Amsterdam, The Netherlands
| | | | - Maria G Van Pampus
- Department of Obstetrics and Gynaecology, OLVG, Oosterpark 9, Amsterdam, The Netherlands
| | - Odile A van den Heuvel
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Compulsivity, Impulsivity and Attention Program, Amsterdam, The Netherlands
| | - Birit F P Broekman
- Department of Psychiatry and Medical Psychology, OLVG, Oosterpark 9, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Amsterdam Public Health Program, Amsterdam, 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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Raoust G, Kajonius P, Hansson S. Personality traits and decision-making styles among obstetricians and gynecologists managing childbirth emergencies. Sci Rep 2023; 13:5607. [PMID: 37020041 PMCID: PMC10076329 DOI: 10.1038/s41598-023-32658-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 03/30/2023] [Indexed: 04/07/2023] Open
Abstract
The successful management of a childbirth emergency will be dependent on the decision-making of involved obstetricians and gynecologists. Individual differences in decision-making may be explained through personality traits. The objectives of the present study were (I) to describe personality trait levels of obstetricians and gynecologists and (II) to examine the relationship between obstetricians' and gynecologists' personality traits and decision-making styles (Individual, Team and Flow) in childbirth emergencies; also controlling for cognitive ability (ICAR-3), age, sex and years of clinical experience. Obstetricians and gynecologists, members of the Swedish Society for Obstetrics and Gynecology (N = 472) responded to an online questionnaire that included a simplified version of the Five Factor Model of personality (IPIP-NEO), and 15 questions concerning childbirth emergencies based on a model of decision-making styles (Individual, Team and Flow). The data was analyzed using Pearson's correlation analysis and multiple linear regression. Swedish obstetricians and gynecologists scored (P < 0.001) lower on Neuroticism (Cohen's d = - 1.09) and higher on Extraversion (d = 0.79), Agreeableness (d = 1.04) and Conscientiousness (d = 0.97) compared to the general population. The most important trait was Neuroticism, which correlated with the decision-making styles Individual (r = - 0.28) and Team (r = 0.15), while for example Openness only trivially correlated with Flow. Multiple linear regression showed that personality traits with covariates explained up to 18% of decision-making styles. Obstetricians and gynecologists have notably more distinct personality levels than the general population, and their personality traits relate to decision-making in childbirth emergencies. The assessment of medical errors in childbirth emergencies and prevention through individualized training should take account of these findings.
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Affiliation(s)
- Gabriel Raoust
- Division of Obstetrics and Gynecology, Department of Clinical Sciences Lund, Lund University, BMC C14, 221 84, Lund, Sweden.
- Women's Health Clinic, Ystad Hospital, Kristianstadvägen 3A, 271 33, Ystad, Sweden.
| | - Petri Kajonius
- Department of Psychology, Lund University, Box 213, 221 00, Lund, Sweden
| | - Stefan Hansson
- Division of Obstetrics and Gynecology, Department of Clinical Sciences Lund, Lund University, BMC C14, 221 84, Lund, Sweden
- Women's Health Clinic, Skåne University Hospital, Klinikgatan 12, 221 85, Lund, Sweden
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Cormier J, Merrer J, Blondel B, Le Ray C. Influence of the maternity unit and region of delivery on episiotomy practice in France: a nationwide population-based study. Acta Obstet Gynecol Scand 2023; 102:438-449. [PMID: 36852493 PMCID: PMC10008350 DOI: 10.1111/aogs.14522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Our objective was to identify factors associated with episiotomy practice in France, in particular, characteristics of the maternity units and regions of delivery. MATERIAL AND METHODS We performed a national cross-sectional population-based study in all French maternity units in 2016 including 9284 women with vaginal delivery. Our outcome was the performance of an episiotomy. After stratification for parity, associations of episiotomy practice with individual and organizational characteristics and the region of delivery were estimated with multilevel logistic regression models. The variability in maternity unit episiotomy rates explained by the characteristics studied was estimated by the proportional change in variance. RESULTS A total of 19.9% of the women had an episiotomy. The principal factors associated with episiotomy practice were maternal and obstetric and delivery in a maternity unit with <2000 annual deliveries. After adjusting for individual, obstetric and organizational characteristics, the practice of episiotomy was strongly associated with women's region of delivery. Additionally, women's individual characteristics did not explain the significant variability in episiotomy rates between maternity units (P < 0.001) but maternity unit characteristics partly did (proportion of variance explained: 7.2% for primiparas and 13.6% for multiparas) and regional differences still more (18% and 30.7%, respectively). CONCLUSIONS Episiotomy practices in France in 2016 varied strongly between maternity units, largely due to regional differences. Targeted actions by the regional perinatal care networks may reduce the national episiotomy rate and standardize practices.
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Affiliation(s)
- Julie Cormier
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and StatisticsUniversité de Paris, INSERM, INRAParisFrance
- Port‐Royal Maternity, AP‐HPHôpital Cochin, FHU PREMAParisFrance
| | - Jade Merrer
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and StatisticsUniversité de Paris, INSERM, INRAParisFrance
- Clinical Epidemiology Unit, Robert Debré HospitalAssistance Publique‐Hôpitaux de ParisParisFrance
| | - Béatrice Blondel
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and StatisticsUniversité de Paris, INSERM, INRAParisFrance
| | - Camille Le Ray
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and StatisticsUniversité de Paris, INSERM, INRAParisFrance
- Port‐Royal Maternity, AP‐HPHôpital Cochin, FHU PREMAParisFrance
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Goodarzi B, Seijmonsbergen-Schermers A, Cronie D, van Laerhoven H, van den Akker T, van Kaam AH, de Jonge A. (Un)warranted variation in local hospital protocols for neonatal referral to the pediatrician: An explorative study in the Netherlands. Birth 2023; 50:215-233. [PMID: 36373864 DOI: 10.1111/birt.12690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/23/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies indicate unwarranted variation in a wide range of neonatal care practices, contributing to preventable morbidity and mortality. Unwarranted variation is the result of complex interactions and multiple determinants. One of the determinants contributing to unwarranted variation in care may be variation in local hospital protocols. The purpose of this study was to examine variation in the content of obstetric and neonatal protocols for six common indications for neonatal referral to the pediatrician: large for gestational age/macrosomia, small for gestational age/fetal growth restriction, meconium-stained amniotic fluid, vacuum extraction, forceps extraction, and cesarean birth. METHODS We conducted a nationwide cross-sectional study examining protocols for neonatal referral to the pediatrician in the obstetric and neonatal departments of all Dutch hospitals. Variation in protocols was analyzed between regions, between neonatal and obstetrics departments located in the same hospital, and within neonatal and obstetrics departments. RESULTS There was considerable variation in protocols between regions, between neonatal and obstetrics departments, and within neonatal and obstetrics departments. The results of this study showed considerable variation in recommendations for type of referral, admission, screening/diagnostic tests, treatment, and discharge. Furthermore, results generally showed lower referral thresholds in neonatal departments compared with obstetric departments, and higher referral thresholds in the eastern region of the Netherlands. We also found variation in local hospital protocols, which could not be explained by population characteristics but which may be explained by varying recommendations in existing national and international guidelines and/or lack of adherence to these guidelines. CONCLUSIONS To reduce unwarranted variation in local protocols, evidence-based, multidisciplinary guidelines should be developed in the Netherlands. Further research addressing knowledge gaps is needed to inform these guidelines. Attention should be paid to the implementation of evidence, and only where evidence is lacking or inconclusive should agreements be based on multidisciplinary consensus. Where protocols deviate from evidence-based guidelines because of specific local circumstances, clearer, more transparent justifications should be made. Uniformity in guidance will offer clear standards for care evaluation and provide opportunities to reduce inappropriate care.
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Affiliation(s)
- Bahareh Goodarzi
- Department of Midwifery Science, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Midwifery Academy Amsterdam Groningen, Amsterdam, The Netherlands.,Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands.,Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Anna Seijmonsbergen-Schermers
- Department of Midwifery Science, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Midwifery Academy Amsterdam Groningen, Amsterdam, The Netherlands.,Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands.,Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Doug Cronie
- Rotterdam University of Applied Sciences, Institute of Healthcare, Rotterdam, The Netherlands
| | | | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands.,Athena Institute, VU University, Amsterdam, The Netherlands.,Department of neonatology, Emma Children's Hospital, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Anton H van Kaam
- Department of neonatology, Emma Children's Hospital, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Ank de Jonge
- Department of Midwifery Science, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Midwifery Academy Amsterdam Groningen, Amsterdam, The Netherlands.,Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Amsterdam Reproduction and Development, Amsterdam, The Netherlands
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Declercq E, Wolterink A, Rowe R, de Jonge A, De Vries R, Nieuwenhuijze M, Verhoeven C, Shah N. The natural pattern of birth timing and gestational age in the U.S. compared to England, and the Netherlands. PLoS One 2023; 18:e0278856. [PMID: 36652413 PMCID: PMC9847908 DOI: 10.1371/journal.pone.0278856] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/27/2022] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To examine cross-national differences in gestational age over time in the U.S. and across three wealthy countries in 2020 as well as examine patterns of birth timing by hour of the day in home and spontaneous vaginal hospital births in the three countries. METHODS We did a comparative cohort analysis with data on gestational age and the timing of birth from the United States, England and the Netherlands, comparing hospital and home births. For overall gestational age comparisons, we drew on national birth cohorts from the U.S. (1990, 2014 & 2020), the Netherlands (2014 & 2020) and England (2020). Birth timing data was drawn from national data from the U.S. (2014 & 2020), the Netherlands (2014) and from a large representative sample from England (2008-10). We compared timing of births by hour of the day in hospital and home births in all three countries. RESULTS The U.S. overall mean gestational age distribution, based on last menstrual period, decreased by more than half a week between 1990 (39.1 weeks) and 2020 (38.5 weeks). The 2020 U.S. gestational age distribution (76% births prior to 40 weeks) was distinct from England (60%) and the Netherlands (56%). The gestational age distribution and timing of home births was comparable in the three countries. Home births peaked in early morning between 2:00 am and 5:00 am. In England and the Netherlands, hospital spontaneous vaginal births showed a generally similar timing pattern to home births. In the U.S., the pattern was reversed with a prolonged peak of spontaneous vaginal hospital births between 8:00 am to 5:00 pm. CONCLUSIONS The findings suggest organizational priorities can potentially disturb natural patterns of gestation and birth timing with a potential to improve U.S. perinatal outcomes with organizational models that more closely resemble those of England and the Netherlands.
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Affiliation(s)
- Eugene Declercq
- Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Anneke Wolterink
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG/ Amsterdam Public Health, Amsterdam, The Netherlands
| | - Rachel Rowe
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England
| | - Ank de Jonge
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG/ Amsterdam Public Health, Amsterdam, The Netherlands
| | - Raymond De Vries
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | | | - Corine Verhoeven
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG/ Amsterdam Public Health, Amsterdam, The Netherlands
| | - Neel Shah
- Department of Obstetrics, Gynecology and Reproductive Biology Harvard Medical School, Boston, Massachusetts, United States of America
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Zondag DC, van Haaren-Ten Haken TM, Offerhaus PM, Maas VYF, Nieuwenhuijze MJ. Knowledge and skills used for clinical decision-making on childbirth interventions: A qualitative study among midwives in the Netherlands. Eur J Midwifery 2022; 6:56. [PMID: 36119405 PMCID: PMC9434498 DOI: 10.18332/ejm/151653] [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: 05/12/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Appropriate use of interventions in maternity care is a worldwide issue. Midwifery-led models of care are associated with more efficient use of resources, fewer medical interventions, and improved outcomes. However, the use of interventions varies considerably between midwives. The aim of this study was to explore how knowledge and skills influence clinical decision-making of midwives on the appropriate use of childbirth interventions. METHODS A qualitative study using in-depth interviews with 20 primary care midwives was performed in June 2019. Participants’ clinical experience varied in the use of interventions. The interviews combined a narrative approach with a semi-structured question route. Data were analyzed using deductive content analysis. RESULTS ‘Knowledge’, ‘Critical thinking skills’, and ‘Communication skills’ influenced midwives’ clinical decision-making towards childbirth interventions. Midwives obtained their knowledge through the formal education program and extended their knowledge by reflecting on experiences and evidence. Midwives with a low use of interventions seem to have a higher level of reflective skills, including reflection-in-action. These midwives used a more balanced communication style with instrumental and affective communication skills in interaction with women, and have more skills to engage in discussions during collaboration with other professionals, and thus personalizing their care. CONCLUSIONS Midwives with a low use of interventions seemed to have the knowledge and skills of a reflective practitioner, leading to more personalized care compared to standardized care as defined in protocols. Learning through reflectivity, critical thinking skills, and instrumental and affective communication skills, need to be stimulated and trained to pursue appropriate, personalized use of interventions.
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Affiliation(s)
- Dirkje C. Zondag
- Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC), Maastricht University, Maastricht, Netherlands
| | | | - Pien M. Offerhaus
- Research Centre for Midwifery Science, Zuyd University, Maastricht, Netherlands
| | - Veronique Y. F. Maas
- Department of Obstetrics and Gynaecology, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Marianne J. Nieuwenhuijze
- Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC), Maastricht University, Maastricht, Netherlands
- Research Centre for Midwifery Science, Zuyd University, Maastricht, Netherlands
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Croll DMR, Meuleman T, de Heus R, de Boer MA, Verhoeven CJM, Bloemenkamp KWM, van Dillen J. Pregnant women's willingness to participate in a randomized trial comparing induction of labor at 39 weeks versus expectant management: A survey in the Netherlands. Eur J Obstet Gynecol Reprod Biol 2022; 273:7-11. [PMID: 35436644 DOI: 10.1016/j.ejogrb.2022.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 03/26/2022] [Accepted: 03/29/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION A randomized controlled trial (RCT) in the United States, the ARRIVE trial, has indicated that induction of labor (IOL) in low-risk nulliparous women with a gestational age (GA) of 39 weeks compared to expectant management (EM) resulted in a significant lower rate of cesarean deliveries. The Dutch maternity care system is different compared to the United States with, among other factors, an overall significantly lower percentage of caesarean sections (CS). To investigate whether IOL has a favorable outcome in the Dutch maternity care system, a new trial is advised. In this questionnaire-based study we aim to evaluate whether Dutch low-risk pregnant women would be willing to participate in an RCT comparing IOL at 39 weeks to EM. MATERIALS AND METHODS We conducted an online survey in 2020 in the Netherlands. Respondent recruitment took place both in outpatient clinics at hospitals and midwife practices and via social media. Inclusion criteria were pregnant women with singleton gestation, GA ≤ 39 weeks, age 18 years or older and residency in the Netherlands. Exclusion criteria were multiple gestation, a history of a CS, planned IOL or CS in current pregnancy and GA > 39 weeks. A subgroup was formed of low risk (receiving primary care) nulliparous women with a gestational age between 34 and 39 weeks, comparable with the ARRIVE trial. RESULTS Three hundred eighty respondents participated. Of all respondents (nulli- and multiparous), 47 (12.4%) would be willing to participate in the hypothetical RCT and 70 (18.4%) might be willing to participate. Amongst the 70 women in the subgroup 11 women (15.7%) would be willing to participate and 17 (24.3%) might be willing to participate. DISCUSSION AND CONCLUSION Calculating sample size in a country with a low CS rate, in relation to 69.2% of women are not willing to participate in an RCT comparing IOL at 39 weeks with EM, would require >18.000 women to be counselled for participation. We believe such a study is a challenge in the Netherlands.
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Affiliation(s)
- Dorothée M R Croll
- Wilhelmina's Children Hospital, UMC Utrecht, Department of Obstetrics, Division Woman and Baby, Utrecht, the Netherlands.
| | - Tessa Meuleman
- Radboud Medical Centre, Department of Obstetrics, Nijmegen, the Netherlands
| | - Roel de Heus
- St. Antonius Hospital, Department of Gynecology & Obstetrics, Utrecht, the Netherlands
| | - Marjon A de Boer
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Obstetrics and Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Pregnancy and Birth, Amsterdam, the Netherlands
| | - Corine J M Verhoeven
- Amsterdam UMC, Location VUmc, Midwifery Science, AVAG, APH Research Institute, Amsterdam, the Netherlands; Division of Midwifery, School of Health Sciences, University of Nottingham, United Kingdom; Maxima Medical Center, Department of Obstetrics and Gynecology, Veldhoven, the Netherlands
| | - Kitty W M Bloemenkamp
- Wilhelmina's Children Hospital, UMC Utrecht, Department of Obstetrics, Division Woman and Baby, Utrecht, the Netherlands
| | - Jeroen van Dillen
- Radboud Medical Centre, Department of Obstetrics, Nijmegen, the Netherlands
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Alòs-Pereñíguez S, O'Malley D, Daly D. Women’s views and experiences of augmentation of labour with synthetic oxytocin infusion. A protocol for a qualitative evidence synthesis. HRB Open Res 2022; 4:127. [PMID: 35187397 PMCID: PMC8822135 DOI: 10.12688/hrbopenres.13467.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Augmentation of labour (AOL) is the most common intervention to treat labour dystocia. Previous research reported extensive disparities in AOL rates across countries and institutions. Despite its widespread use, women’s views on and experiences of intrapartum augmentation with infused synthetic oxytocin are limited. Methods: A qualitative evidence synthesis on women’s views and experiences of AOL with synthetic oxytocin after spontaneous onset of labour will be conducted. Qualitative studies and studies employing a mixed methods design, where qualitative data can be extracted separately, will be included, as will surveys with open-ended questions that provide qualitative data. A systematic search will be performed of the databases: MEDLINE, CINAHL, EMBASE, PsycINFO, Maternity and Infant Care and Web of Science Core Collection from the date of inception. The methodological quality of included studies will be assessed using the Evidence for Policy and Practice Information and Co-ordinating Centre’s appraisal tool. A three-stage approach, coding of data from primary studies, development of descriptive themes and generation of analytical themes, will be used to synthesise findings. Confidence in findings will be established by the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research. Discussion: This qualitative evidence synthesis may provide valuable information on women’s experiences of AOL and contribute to a review of clinical practice guidelines for maternity care providers. PROSPERO registration: CRD42021285252 (14/11/2021)
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Affiliation(s)
- Silvia Alòs-Pereñíguez
- School of Nursing & Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin, D02 T283, Ireland
| | - Deirdre O'Malley
- School of Nursing & Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin, D02 T283, Ireland
- Nursing, Midwifery & Health Studies, Dundalk Institute of Technology, Dundalk, A91 K584, Ireland
| | - Deirdre Daly
- School of Nursing & Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin, D02 T283, Ireland
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12
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Raoust GM, Bergström J, Bolin M, Hansson SR. Decision-making during obstetric emergencies: A narrative approach. PLoS One 2022; 17:e0260277. [PMID: 35081113 PMCID: PMC8791468 DOI: 10.1371/journal.pone.0260277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 11/07/2021] [Indexed: 11/17/2022] Open
Abstract
This study aims to explore how physicians make sense of and give meaning to their decision-making during obstetric emergencies. Childbirth is considered safe in the wealthiest parts of the world. However, variations in both intervention rates and delivery outcomes have been found between countries and between maternity units of the same country. Interventions can prevent neonatal and maternal morbidity but may cause avoidable harm if performed without medical indication. To gain insight into the possible causes of this variation, we turned to first-person perspectives, and particularly physicians’ as they hold a central role in the obstetric team. This study was conducted at four maternity units in the southern region of Sweden. Using a narrative approach, individual in-depth interviews ignited by retelling an event and supported by art images, were performed between Oct. 2018 and Feb. 2020. In total 17 obstetricians and gynecologists participated. An inductive thematic narrative analysis was used for interpreting the data. Eight themes were constructed: (a) feeling lonely, (b) awareness of time, (c) sense of responsibility, (d) keeping calm, (e) work experience, (f) attending midwife, (g) mind-set and setting, and (h) hedging. Three decision-making perspectives were constructed: (I) individual-centered strategy, (II) dialogue-distributed process, and (III) chaotic flow-orientation. This study shows how various psychological and organizational conditions synergize with physicians during decision-making. It also indicates how physicians gave decision-making meaning through individual motivations and rationales, expressed as a perspective. Finally, the study also suggests that decision-making evolves with experience, and over time. The findings have significance for teamwork, team training, patient safety and for education of trainees.
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Affiliation(s)
- Gabriel M. Raoust
- Department of Clinical Sciences Lund, Division of Obstetrics and Gynecology, Faculty of Medicine, Lund University, Lund, Sweden
- Women’s Health Clinic, Ystad Hospital, Ystad, Sweden
- * E-mail:
| | - Johan Bergström
- Division for Risk Management and Societal Safety, Faculty of Engineering, Lund University, Lund, Sweden
| | - Maria Bolin
- Department of Applied Information Technology, University of Gothenburg, Gothenburg, Sweden
| | - Stefan R. Hansson
- Department of Clinical Sciences Lund, Division of Obstetrics and Gynecology, Faculty of Medicine, Lund University, Lund, Sweden
- Women’s Health Clinic, Skåne University Hospital, Lund, Sweden
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Alòs-Pereñíguez S, O'Malley D, Daly D. Women’s views and experiences of augmentation of labour with synthetic oxytocin infusion: a protocol for a qualitative evidence synthesis. HRB Open Res 2021; 4:127. [DOI: 10.12688/hrbopenres.13467.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Augmentation of labour (AOL) is the most common intervention to treat labour dystocia. Previous research reported extensive disparities in AOL rates across countries and institutions. Despite its widespread use, women’s views on and experiences of intrapartum augmentation with infused synthetic oxytocin are limited. Methods: A qualitative evidence synthesis on women’s views and experiences of AOL with synthetic oxytocin after spontaneous onset of labour will be conducted. Qualitative studies and studies employing a mixed methods design, where qualitative data can be extracted separately, will be included, as will surveys with open-ended questions that provide qualitative data. A systematic search will be performed of the databases: MEDLINE, CINAHL, EMBASE, PsycINFO, Maternity and Infant Care and Web of Science Core Collection from the date of inception. The methodological quality of included studies will be assessed using the Evidence for Policy and Practice Information and Co-ordinating Centre’s appraisal tool. A three-stage approach, coding of data from primary studies, development of descriptive themes and generation of analytical themes, will be used to synthesise findings. Confidence in findings will be established by the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research. Discussion: This qualitative evidence synthesis may provide valuable information on women’s experiences of AOL and contribute to a review of clinical practice guidelines for maternity care providers. PROSPERO registration: CRD42021285252 (14/11/2021)
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Liberati EG, Tarrant C, Willars J, Draycott T, Winter C, Kuberska K, Paton A, Marjanovic S, Leach B, Lichten C, Hocking L, Ball S, Dixon-Woods M. Seven features of safety in maternity units: a framework based on multisite ethnography and stakeholder consultation. BMJ Qual Saf 2021; 30:444-456. [PMID: 32978322 PMCID: PMC8142434 DOI: 10.1136/bmjqs-2020-010988] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/11/2020] [Accepted: 08/21/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Reducing avoidable harm in maternity services is a priority globally. As well as learning from mistakes, it is important to produce rigorous descriptions of 'what good looks like'. OBJECTIVE We aimed to characterise features of safety in maternity units and to generate a plain language framework that could be used to guide learning and improvement. METHODS We conducted a multisite ethnography involving 401 hours of non-participant observations 33 semistructured interviews with staff across six maternity units, and a stakeholder consultation involving 65 semistructured telephone interviews and one focus group. RESULTS We identified seven features of safety in maternity units and summarised them into a framework, named For Us (For Unit Safety). The features include: (1) commitment to safety and improvement at all levels, with everyone involved; (2) technical competence, supported by formal training and informal learning; (3) teamwork, cooperation and positive working relationships; (4) constant reinforcing of safe, ethical and respectful behaviours; (5) multiple problem-sensing systems, used as basis of action; (6) systems and processes designed for safety, and regularly reviewed and optimised; (7) effective coordination and ability to mobilise quickly. These features appear to have a synergistic character, such that each feature is necessary but not sufficient on its own: the features operate in concert through multiple forms of feedback and amplification. CONCLUSIONS This large qualitative study has enabled the generation of a new plain language framework-For Us-that identifies the behaviours and practices that appear to be features of safe care in hospital-based maternity units.
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Affiliation(s)
- Elisa Giulia Liberati
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester, Leicestershire, UK
| | - Janet Willars
- Department of Health Sciences, University of Leicester, Leicester, Leicestershire, UK
| | - Tim Draycott
- Department of Translational Health Sciences, University of Bristol, Bristol, UK
- PROMPT Maternity Foundation, Bristol, UK
| | | | - Karolina Kuberska
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Alexis Paton
- Department of Sociology and Policy, Aston Medical School, Aston University, Birmingham, UK
| | - Sonja Marjanovic
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
- RAND Europe, Cambridge, Cambridgeshire, UK
| | | | | | | | - Sarah Ball
- RAND Europe, Cambridge, Cambridgeshire, UK
| | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
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15
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Lorentzen IP, Andersen CS, Jensen HS, Fogsgaard A, Foureur M, Lauszus FF, Nohr EA. Does giving birth in a "birth environment room" versus a standard birth room lower augmentation of labor? - Results from a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol X 2021; 10:100125. [PMID: 33817626 PMCID: PMC8010388 DOI: 10.1016/j.eurox.2021.100125] [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: 11/05/2020] [Revised: 02/05/2021] [Accepted: 03/08/2021] [Indexed: 11/03/2022] Open
Abstract
Objective In the last decade, there has been an increased interest in exploring the impact of the physical birth environment on midwifery practice and women's birth experiences. This study is based on the hypothesis that the environment for birth needs greater attention to improve some of the existing challenges in modern obstetric practice, for example the increasing use of augmentation and number of interventions during delivery. Study design A randomized controlled trial was carried out to study the effect of giving birth in a specially designed "birth environment room" on the use of augmentation during labor. The study took place at the Department of Obstetrics and Gynecology, Herning Hospital, Denmark and included 680 nulliparous women in spontaneous labor at term with a fetus in cephalic presentation. Women were randomly allocated to either the "birth environment room" or a standard birth room. The primary outcome was augmentation of labor by use of oxytocin. Secondary outcomes were duration of labor, use of pharmacological pain relief, and mode of birth. Differences were estimated as relative risks (RR) and presented with 95% confidence intervals. Results No difference was found on the primary outcome, augmentation of labor (29.1% in the "birth environment room" versus 30.6% in the standard room, RR 0.97; 0.89-1.08). More women in the "birth environment room" used the bathtub (60.6% versus 52.4%, RR 1.18; 1.02-1.37), whereas a tendency to lower use of epidural analgesia (22.6% versus 28.2%) did not reach statistical significance (RR 0.87; 0.74-1.02). The chance of an uncomplicated birth was almost similar in the two groups (70.6% in the "birth environment room" versus 72.6% in the standard room, RR 0.97; 0.88-1.07) as were duration of labor (mean 7.9 hours in both groups). Conclusions Birthing in a specially designed physical birth environment did not lower use of oxytocin for augmentation of labor. Neither did it have any effect on duration of labor, use of pharmacological pain relief, and chance of birthing without complications. We recommend that future trials are conducted in birth units with greater improvement potentials.
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Affiliation(s)
| | - Charlotte S Andersen
- Department of Gynecology and Obstetrics, Gl. Landevej 61, 7400, Herning, Denmark
| | | | - Ann Fogsgaard
- Department of Gynecology and Obstetrics, Gl. Landevej 61, 7400, Herning, Denmark
| | - Maralyn Foureur
- Nursing and Midwifery Research Centre, Hunter New England Health and University of Newcastle, NSW, 2300, Australia
| | - Finn Friis Lauszus
- Department of Gynecology and Obstetrics, Gl. Landevej 61, 7400, Herning, Denmark
| | - Ellen Aagaard Nohr
- Research Unit for Obstetrics and Gynecology, Institute of Clinical Research, University of Southern Denmark, Campusvej 55, 5230, Odense C, Denmark.,Centre of Women's, Family and Child Health, University of South-Eastern Norway, Kongsberg, Norway
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16
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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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Gu C, Wang X, Zhang Z, Schwank S, Zhu C, Zhang Z, Qian X. Pregnant women's clinical characteristics, intrapartum interventions, and duration of labour in urban China: a multi-center cross-sectional study. BMC Pregnancy Childbirth 2020; 20:386. [PMID: 32616073 PMCID: PMC7330978 DOI: 10.1186/s12884-020-03072-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/19/2020] [Indexed: 12/19/2022] Open
Abstract
Background There is an increasing global trend towards the widespread over-medicalisation of labour and childbirth. The present study aimed to investigate pregnant women’s clinical characteristics, intrapartum interventions, duration of labour and its associated factors; and to compare the differences of these variables between nulliparas and multiparas in China. Methods A multi-center cross-sectional study was carried out in three tertiary hospitals of Fudan University in Shanghai, China. A total of 1523 participants were approched and assessed for eligibility. Data on women’s sociodemographic characteristics, intrapartum interventions, and duration of labour were measured and collected. Kaplan-Meier survival analysis was performed to present the curves of total duration of labour by parity. After z-transformation of labour duration, multivariable linear regression was used to control for confounding and to identify independent associations between potential associated factors and the primary outcome of labour duration. Results Overall, 1209 eligible women agreed to participate and were investigated. Rates of different intrapartum interventions were 27.4% in use of amniotomy, 37.9% in use of oxytocin, 53.0% in continuous electronic fetal monitoring, and 52.9% in epidural use, respectively. The curve of total duration of labour was significantly different between nulliparas and multiparas (P < .001). Of the 1209 participants, 983 (81.3%) women eventually achieved successful vaginal birth while 226 (18.7%) women ended in intrapartum caesarean section. The median duration of total stage of labour was significantly longer in the nulliparous group [9.38 (6.33,14.10) hours] than that in the multiparous group [5.08 (3.00,7.83) hours] (P < .001). The following factors were independently associated with longer duration of total stage of labour: epidural analgesia (P < .001), primiparity (P < .001), continuous electronic fetal monitoring (P = .035), and increased birth weight (P = .005). Conclusions Intrapartum medical interventions become common obstetric practices in urban China. Multifactorial variables independently associated with longer duration of labour were identified, including epidural analgesia, primiparity, continuous electronic fetal monitoring, and increased birth weight. Further research is required to validate these variables and to determine the modifiable factors for labour management. And models of care with lower intervention rates such as midwife-led models of care should be developed and implemented in China.
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Affiliation(s)
- Chunyi Gu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China.,Department of Nursing, Obstetrics & Gynaecology Hospital of Fudan University, Shanghai, China
| | - Xiaojiao Wang
- Department of Nursing, Obstetrics & Gynaecology Hospital of Fudan University, Shanghai, China
| | - Zhijie Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Simone Schwank
- Department of Women and Children's Health, Reproductive Health, Karolinska Institutet, Stockholm, Sweden
| | - Chunxiang Zhu
- Department of Nursing, Obstetrics & Gynaecology Hospital of Fudan University, Shanghai, China
| | - Zheng Zhang
- Department of Nursing, Obstetrics & Gynaecology Hospital of Fudan University, Shanghai, China
| | - Xu Qian
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China. .,Global Health Institute, Fudan University, Shanghai, China.
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Seijmonsbergen-Schermers AE, van den Akker T, Rydahl E, Beeckman K, Bogaerts A, Binfa L, Frith L, Gross MM, Misselwitz B, Hálfdánsdóttir B, Daly D, Corcoran P, Calleja-Agius J, Calleja N, Gatt M, Vika Nilsen AB, Declercq E, Gissler M, Heino A, Lindgren H, de Jonge A. Variations in use of childbirth interventions in 13 high-income countries: A multinational cross-sectional study. PLoS Med 2020; 17:e1003103. [PMID: 32442207 PMCID: PMC7244098 DOI: 10.1371/journal.pmed.1003103] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 04/13/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Variations in intervention rates, without subsequent reductions in adverse outcomes, can indicate overuse. We studied variations in and associations between commonly used childbirth interventions and adverse outcomes, adjusted for population characteristics. METHODS AND FINDINGS In this multinational cross-sectional study, existing data on 4,729,307 singleton births at ≥37 weeks in 2013 from Finland, Sweden, Norway, Denmark, Iceland, Ireland, England, the Netherlands, Belgium, Germany (Hesse), Malta, the United States, and Chile were used to describe variations in childbirth interventions and outcomes. Numbers of births ranged from 3,987 for Iceland to 3,500,397 for the USA. Crude data were analysed in the Netherlands, or analysed data were shared with the principal investigator. Strict variable definitions were used and information on data quality was collected. Intervention rates were described for each country and stratified by parity. Uni- and multivariable analyses were performed, adjusted for population characteristics, and associations between rates of interventions, population characteristics, and outcomes were assessed using Spearman's rank correlation coefficients. Considerable intercountry variations were found for all interventions, despite adjustments for population characteristics. Adjustments for ethnicity and body mass index changed odds ratios for augmentation of labour and episiotomy. Largest variations were found for augmentation of labour, pain relief, episiotomy, instrumental birth, and cesarean section (CS). Percentages of births at ≥42 weeks varied from 0.1% to 6.7%. Rates among nulliparous versus multiparous women varied from 56% to 80% versus 51% to 82% for spontaneous onset of labour; 14% to 36% versus 8% to 28% for induction of labour; 3% to 13% versus 7% to 26% for prelabour CS; 16% to 48% versus 12% to 50% for overall CS; 22% to 71% versus 7% to 38% for augmentation of labour; 50% to 93% versus 25% to 86% for any intrapartum pain relief, 19% to 83% versus 10% to 64% for epidural anaesthesia; 6% to 68% versus 2% to 30% for episiotomy in vaginal births; 3% to 30% versus 1% to 7% for instrumental vaginal births; and 42% to 70% versus 50% to 84% for spontaneous vaginal births. Countries with higher rates of births at ≥42 weeks had higher rates of births with a spontaneous onset (rho = 0.82 for nulliparous/rho = 0.83 for multiparous women) and instrumental (rho = 0.67) and spontaneous (rho = 0.66) vaginal births among multiparous women and lower rates of induction of labour (rho = -0.71/-0.66), prelabour CS (rho = -0.61/-0.65), overall CS (rho = -0.61/-0.67), and episiotomy (multiparous: rho = -0.67). Variation in CS rates was mainly due to prelabour CS (rho = 0.96). Countries with higher rates of births with a spontaneous onset had lower rates of emergency CS (nulliparous: rho = -0.62) and higher rates of spontaneous vaginal births (multiparous: rho = 0.70). Prelabour and emergency CS were positively correlated (nulliparous: rho = 0.74). Higher rates of obstetric anal sphincter injury following vaginal birth were found in countries with higher rates of spontaneous birth (nulliparous: rho = 0.65). In countries with higher rates of epidural anaesthesia (nulliparous) and spontaneous births (multiparous), higher rates of Apgar score < 7 were found (rhos = 0.64). No statistically significant variation was found for perinatal mortality. Main limitations were varying quality of data and missing information. CONCLUSIONS Considerable intercountry variations were found for all interventions, even after adjusting for population characteristics, indicating overuse of interventions in some countries. Multivariable analyses are essential when comparing intercountry rates. Implementation of evidence-based guidelines is crucial in optimising intervention use and improving quality of maternity care worldwide.
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Affiliation(s)
- Anna E. Seijmonsbergen-Schermers
- Department of Midwifery Science, AVAG, Amsterdam Public Health research institute, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
- * E-mail:
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Eva Rydahl
- University College Copenhagen, Department of Midwifery, Copenhagen NV, Denmark
| | - Katrien Beeckman
- Nursing and Midwifery Research unit, faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Annick Bogaerts
- Department of Development and Regeneration KU Leuven, University of Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Belgium
| | - Lorena Binfa
- Department of Women´s and Newborn Health Promotion-School of Midwifery, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Lucy Frith
- Department of Health Services Research, The University of Liverpool, Liverpool, United Kingdom
| | - Mechthild M. Gross
- Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology and Reproductive Medicine, Hannover Medical School, Hannover, Germany
| | | | - Berglind Hálfdánsdóttir
- Midwifery Programme, Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Paul Corcoran
- National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Jean Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Tal-Qroqq, Msida, Malta
| | - Neville Calleja
- Directorate for Health Information and Research, Gwardamangia, Malta
- Department of Public Health Department, Faculty of Medicine and Surgery, University of Malta, Tal-Qroqq, Msida, Malta
| | - Miriam Gatt
- Directorate for Health Information and Research, Gwardamangia, Malta
| | - Anne Britt Vika Nilsen
- Western Norway University of Applied Sciences (HVL), Department of Health and Caring Sciences, Bergen, Norway
| | - Eugene Declercq
- Boston University School of Public Health, Boston, United States of America
| | - Mika Gissler
- THL Finnish Institute for Health and Welfare, Information Services Department, Helsinki, Finland
- Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Huddinge, Sweden
| | - Anna Heino
- THL Finnish Institute for Health and Welfare, Information Services Department, Helsinki, Finland
| | - Helena Lindgren
- Department of Women’s and Children’s Health, Karolinska Institutet, Solna, Sweden
| | - Ank de Jonge
- Department of Midwifery Science, AVAG, Amsterdam Public Health research institute, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
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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
- * E-mail:
| | - 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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Gitsels-van der Wal JT, Gitsels LA, Hooker A, van Weert B, Martin L, Feijen-de Jong EI. Determinants and underlying causes of frequent attendance in midwife-led care: an exploratory cross-sectional study. BMC Pregnancy Childbirth 2019; 19:203. [PMID: 31208355 PMCID: PMC6580473 DOI: 10.1186/s12884-019-2316-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/25/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND An adequate number of prenatal consultations is beneficial to the health of the mother and fetus. Guidelines recommend an average of 5-14 consultations. Daily practice, however, shows that some women attend the midwifery practice more frequently. This study examined factors associated with frequent attendance in midwifery-led care. METHODS We conducted a cross-sectional study in a large midwifery practice in the Netherlands among low-risk women who started prenatal care in 2015 and 2016. Based on Andersen's behavioral model, we collected data on potential determinants from the digital midwifery's practice database. Prenatal healthcare utilization was measured by a revised version of the Kotelchuck Index, which measures a combination of care entry and numbers of visits. Logistic regression models were fitted to estimate the likelihood of frequent attendance compared to the recommended number of visits, adjusted for all relevant factors. Separate models were fitted on the non-referred and the referred group of obstetric-led care, as referral was found to be an effect modifier. RESULTS The prevalence of frequent attendance was 23% (243/1053), mainly caused by worries and/or vague complaints (44%; 106/243). Among non-referred women, 53% (560/1053), frequent attendance was associated with consultation with an obstetrician (OR = 3.99 (2.35-6.77)) and exposure to sexual violence (OR = 2.17 (1.11-4.24)). Among the referred participants, 47% (493/1053), frequent attendance was associated with a consultation with an obstetrician (OR = 2.75 (1.66-4.57)), psychosocial problems in the past or present (OR = 1.85 (1.02-3.35) or OR = 2.99 (1.43-6.25)), overweight (OR = 1.88 (1.09-3.24)), and deprived area (OR = 0.50 (0.27-0.92)). CONCLUSION Our exploratory study indicates that the determinants of frequent attendance in midwifery-led care differs between non-referred and referred women. Underlying causes for frequent attendance was mainly because of non-medical reasons. IMPLICATION FOR PRACTICE A trustful midwife-client relationship is known to be needed for clients such as frequent attenders to share more detailed, personal stories in case of vague complaints or worries, which is necessary to identify their implicit needs.
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Affiliation(s)
- Janneke T Gitsels-van der Wal
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health research institute, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Lisanne A Gitsels
- ESRC funded Business and Local Government Data Research Centre (BLG DRC), School of Computing Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, England, UK
| | - Angelo Hooker
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands.,Department of Obstetrics and Gynecology, Zaans Medical Center, Koningin Julianaplein 58, Zaandam, Netherlands
| | - Britte van Weert
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health research institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Linda Martin
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health research institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Esther I Feijen-de Jong
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health research institute, De Boelelaan 1117, Amsterdam, The Netherlands.,Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, the Netherlands
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