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Wiegers TA, Hermus MA, Verhoeven CJ, Rijnders ME, van der Pal-de Bruin KM. Job satisfaction of maternity care providers in the Netherlands: Does working in or with a birth centre influence job satisfaction? Eur J Midwifery 2018; 2:11. [PMID: 33537572 PMCID: PMC7846039 DOI: 10.18332/ejm/94279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 08/13/2018] [Accepted: 08/13/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION In the Netherlands birth centres have recently become an alternative option as places where women with uncomplicated pregnancies can give birth. This article focusses on the job satisfaction of three groups of maternity care providers (community midwives, clinical care providers and maternity care assistants) working in or with a birth centre compared to those working only in a hospital or at home. METHODS In 2015, an existing questionnaire was adapted and distributed to maternity care providers and 4073 responses were received. Using factor analyses, two composite measures were constructed, a Composite Job Satisfaction scale and an Assessment-of-Working-in-or-with-a-Birth-Centre scale. Differences between groups were tested with Student’s t-test and MANOVA with post hoc test and linear regression analyses. RESULTS The overall score on the Composite Job Satisfaction scale did not differ between community midwives or clinical care providers working in or with a birth centre and those working in a different setting. For maternity care assistants there was a small but significantly higher score for those not working in a birth centre. Maternity care assistants’ overall job satisfaction score was higher than that of both other groups. In a linear regression analysis working or not working in or with a birth centre was related to the overall job satisfaction score, but repeated for the three professional groups separately, this relation was only found for maternity care assistants. CONCLUSIONS Job satisfaction is generally high, but, except for maternity care assistants, not related to the setting (working or not working in or with a birth centre).
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Affiliation(s)
- Therese A Wiegers
- NIVEL (Netherlands Institute for Health Services Research), The Netherlands
| | - Marieke A Hermus
- Department of Child Health, TNO, The Netherlands, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands, Midwifery Practice Verloskundigen Oosterhout, The Netherlands
| | - Corine J Verhoeven
- Department of Midwifery Science, AVAG/Amsterdam, Public Health Research Institute, VU University Medical Center, Amsterdam, Department of Obstetrics and Gynaecology Maxima Medical Centre, Veldhoven, The Netherlands
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Hermus MAA, Hitzert M, Boesveld IC, van den Akker-van Marle ME, Dommelen PV, Franx A, Graaf JPD, Lith JMMV, Luurssen-Masurel N, Steegers EAP, Wiegers TA, Bruin KMVDPD. Differences in optimality index between planned place of birth in a birth centre and alternative planned places of birth, a nationwide prospective cohort study in The Netherlands: results of the Dutch Birth Centre Study. BMJ Open 2017; 7:e016958. [PMID: 29150465 PMCID: PMC5701986 DOI: 10.1136/bmjopen-2017-016958] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To compare the Optimality Index of planned birth in a birth centre with planned birth in a hospital and planned home birth for low-risk term pregnant women who start labour under the responsibility of a community midwife. DESIGN Prospective cohort study. SETTING Low-risk pregnant women under care of a community midwife and living in a region with one of the 21 participating Dutch birth centres or in a region with the possibility for midwife-led hospital birth. Home birth was commonly available in all regions included in the study. PARTICIPANTS 3455 low-risk term pregnant women (1686 nulliparous and 1769 multiparous) who gave birth between 1 July 2013 and 31 December 2013: 1668 planned birth centre births, 701 planned midwife-led hospital births and 1086 planned home births. MAIN OUTCOME MEASUREMENTS The Optimality IndexNL-2015, a tool to measure 'maximum outcome with minimal intervention', was assessed by planned place of birth being a birth centre, a hospital setting or at home. Also, a composite maternal and perinatal adverse outcome score was calculated for the different planned places of birth. RESULTS There were no differences in Optimality Index NL-2015 for pregnant women who planned to give birth in a birth centre compared with women who planned to give birth in a hospital. Although effect sizes were small, women who planned to give birth at home had a higher Optimality Index NL-2015 than women who planned to give birth in a birth centre. The differences were larger for multiparous than for nulliparous women. CONCLUSION The Optimality Index NL-2015 for women with planned birth centre births was comparable with planned midwife-led hospital births. Women with planned home births had a higher Optimality Index NL-2015, that is, a higher sum score of evidence-based items with an optimal value than women with planned birth centre births.
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Affiliation(s)
- Marieke A A Hermus
- Department of Child Health, TNO (Netherlands Organisation for Applied Scientific Research), Leiden, The Netherlands
- Department of Obstetrics, Leids Universitair Medisch Centrum, Leiden, The Netherlands
- Midwifery Practice Verloskundigen Oosterhout, Werkmansbeemd, Oosterhout, the Netherlands
| | - Marit Hitzert
- Department of Obstetrics and Gynaecology, Erasmus MC university Medical Centre Rotterdam, Rotterdam, The Netherlands
| | | | | | - Paula van Dommelen
- Department of Life Style, TNO (NetherlandsOrganisation for Applied Scientific Research), Leiden, The Netherlands
| | - Arie Franx
- Division of Woman and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Johanna P de Graaf
- Department of Obstetrics and Gynaecology, Erasmus MC university Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jan M M van Lith
- Department of Obstetrics, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Nathalie Luurssen-Masurel
- Department of Child Health, TNO (Netherlands Organisation for Applied Scientific Research), Leiden, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC university Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Therese A Wiegers
- NIVEL(Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Karin M van der Pal-de Bruin
- Department of Child Health, TNO (Netherlands Organisation for Applied Scientific Research), Leiden, The Netherlands
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Boesveld IC, Hermus MAA, de Graaf HJ, Hitzert M, van der Pal-de Bruin KM, de Vries RG, Franx A, Wiegers TA. Developing quality indicators for assessing quality of birth centre care: a mixed- methods study. BMC Pregnancy Childbirth 2017; 17:259. [PMID: 28768487 PMCID: PMC5541423 DOI: 10.1186/s12884-017-1439-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Birth centres are described as settings where women with uncomplicated pregnancies can give birth in a home-like environment assisted by midwives and maternity care assistants. If complications arise or threaten, the woman is referred to a maternity unit of a hospital where an obstetrician will take over responsibility. In the last decade, a number of new birth centres have been established in the Netherlands, based on the assumption that birth centres provide better quality of care since they offer a better opportunity for more integrated care than the existing system with independent primary and secondary care providers. At present, there is no evidence for this assumption. The Dutch Birth Centre Study is designed to present evidence-based recommendations for organization and functioning of future birth centres in the Netherlands. A necessary first step in this evaluation is the development of indicators for measuring the quality of the care delivered in birth centres in the Netherlands. The aim of this study is to identify a comprehensive set of structure and process indicators to assess quality of birth centre care. METHODS We used mixed methods to develop a set of structure and process quality indicators for evaluating birth centre care. Beginning with a literature review, we developed an exhaustive list of determinants. We then used a Delphi study to narrow this list, calling on experts to rate the determinants for relevance and feasibility. A multidisciplinary expert panel of 63 experts, directly or indirectly involved with birth centre care, was invited to participate. RESULTS A panel of 42 experts completed two Delphi rounds rating determinants of the quality of birth centre care based on their relevance (to the setting) and feasibility (of use). A set of 30 determinants for structure and process quality indicators was identified to assess the quality of birth centre care in the Netherlands. CONCLUSIONS We identified 30 determinants for structure and process quality indicators concerning birth centre care. This set will be validated during the evaluation of birth centres in the Dutch Birth Centre Study.
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Affiliation(s)
- Inge C Boesveld
- Jan van Es Institute (Netherlands Expert Centre Integrated Primary Care), Wisselweg 33, 1314 CB Almere, Almere, Netherlands.
| | - Marieke A A Hermus
- Department of Child Health, TNO, PO Box 2215 2301, CE Leiden, Leiden, Netherlands
| | - Hanneke J de Graaf
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, PO Box 2014 3000, CA Rotterdam, Rotterdam, Netherlands
| | - Marit Hitzert
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, PO Box 2014 3000, CA Rotterdam, Rotterdam, Netherlands
| | | | - Raymond G de Vries
- Academie Verloskunde Maastricht/Zuyd University, CAPHRI School for Public Health and Primary Care, PO Box 616 6200, MD Maastricht, Maastricht, Netherlands
| | - Arie Franx
- Division Woman and Baby, University Medical Centre Utrecht, PO Box 85500 3508, GA Utrecht, Utrecht, Netherlands
| | - Therese A Wiegers
- NIVEL (Netherlands Institute for Health Services Research), PO Box 1568 3500, Utrecht, BN, Netherlands
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Boesveld IC, Bruijnzeels MA, Hitzert M, Hermus MAA, van der Pal-de Bruin KM, van den Akker-van Marle ME, Steegers EAP, Franx A, de Vries RG, Wiegers TA. Typology of birth centres in the Netherlands using the Rainbow model of integrated care: results of the Dutch Birth Centre Study. BMC Health Serv Res 2017. [PMID: 28633636 PMCID: PMC5479044 DOI: 10.1186/s12913-017-2350-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background The goal of integrated care is to offer a continuum of care that crosses the boundaries of public health, primary, secondary, and tertiary care. Integrated care is increasingly promoted for people with complex needs and has also recently been promoted in maternity care systems to improve the quality of care. Especially when located near an obstetric unit, birth centres are considered to be ideal settings for the realization of integrated care. At present, however, we know very little about the degree of integration in these centres and we do not know if increased levels of integration improve the quality of the care delivered. The Dutch Birth Centre Study is designed to evaluate birth centres and their contribution to the Dutch maternity care system. The aim of this particular sub-study is to classify birth centres in clusters with similar characteristics based on integration profiles, to support the evaluation of birth centre care. Methods This study is based on the Rainbow Model of Integrated Care. We used a survey followed by qualitative interviews in 23 birth centres in the Netherlands to determine which integration profiles can be distinguished and to describe their discriminating characteristics. Cluster analysis was used to classify the birth centres. Results Birth centres were classified into three clusters: 1)“Mono-disciplinary-oriented birth centres” (n = 10): which are mainly owned by primary care organizations and established as physical facilities to provide an alternative birthplace for low risk births; 2) “Multi-disciplinary-oriented birth centres” (n = 6): which are mainly multi-disciplinary oriented and can be regarded as facilities to give birth, with a focus on integrated birth care; 3) “Mixed Cluster of birth centres” (n = 7): which have a range of organizational forms that differentiate them from centres in the other clusters. Conclusion We identified a recognizable classification, with similar characteristics between birth centres in the clusters. The results of this study can be used to relate integration profiles of birth centres to quality of care, costs, and perinatal outcomes. This assessment makes it possible to develop recommendations with regard to the type and degree of integration of Dutch birth centres in the future. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2350-9) contains supplementary material, which is available to authorized users.
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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.
| | - Marc A Bruijnzeels
- Jan van Es Institute, Netherlands Expert Centre Integrated Primary Care, Wisselweg 33, 1314 CB, Almere, the Netherlands
| | - Marit Hitzert
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, PO Box 2014, 3000 CA, Rotterdam, 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
| | | | - M E van den Akker-van Marle
- Department of Medical Decision Making, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, the Netherlands
| | - Eric A P Steegers
- 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 Netherlands
| | - Raymond G de Vries
- Academie Verloskunde Maastricht/Zuyd University, CAPHRI School for Public Health and Primary Care, PO Box 616, 6200 MD, Maastricht, the Netherlands
| | - Therese A Wiegers
- NIVEL (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN, Utrecht, the Netherlands
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Hitzert M, Hermus MAA, Scheerhagen M, Boesveld IC, Wiegers TA, van den Akker-van Marle ME, van Dommelen P, van der Pal-de Bruin KM, de Graaf JP. Experiences of women who planned birth in a birth centre compared to alternative planned places of birth. Results of the Dutch Birth Centre Study. Midwifery 2016; 40:70-8. [PMID: 27428101 DOI: 10.1016/j.midw.2016.06.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 06/01/2016] [Accepted: 06/06/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE to assess the experiences with maternity care of women who planned birth in a birth centre and to compare them to alternative planned places of birth, by using the responsiveness concept of the World Health Organization. DESIGN this study is a cross-sectional study using the ReproQ questionnaire filled out eight to ten weeks after birth. The primary outcome was responsiveness of birth care. Secondary outcomes included overall grades for birth care and experiences with the birth centre services. Regression analyses were performed to compare experiences among the planned places of birth. The study is part of the Dutch Birth Centre Study. SETTING the women were recruited by 82 midwifery practices in the Netherlands, within the study period 1 August 2013 and 31 December 2013. PARTICIPANTS a total of 2162 women gave written consent to receive the questionnaire and 1181 (54.6%) women completed the questionnaire. MEASUREMENTS AND FINDINGS women who planned to give birth at a birth centre: (1) had similar experiences as the women who planned to give birth in a hospital receiving care of a community midwife. (2) had significantly less favourable experiences than the women who planned to give birth at home. Differences during birth were seen on the domains dignity (OR=1.58, 95% CI=1.09-2.27) and autonomy (OR=1.77, 95% CI=1.25-2.51), during the postpartum period on the domains social considerations (OR=1.54, 95% CI=1.06-2.25) and choice and continuity (OR=1.43, 95% CI=1.00-2.03). (3) had significantly better experiences than the women who planned to give birth in a hospital under supervision of an obstetrician. Differences during birth were seen on the domains dignity (OR=0.51, 95% CI=0.31-0.81), autonomy (OR=0.59, 95% CI=0.35-1.00), confidentiality (OR=0.57, 95% CI=0.36-0.92) and social considerations (OR=0.47, 95% CI=0.28-0.79). During the postpartum period differences were seen on the domains dignity (OR=0.61, 95% CI=0.38-0.98), autonomy (OR=0.52, 95% CI=0.31-0.85) and basic amenities (OR=0.52, 95% CI=0.30-0.88). More than 80% of the women who received care in a birth centre rated the facilities, the moment of arrival/departure and the continuity in the birth centre as good. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE in the last decades, many birth centres have been established in different countries, including the United Kingdom, Australia, Sweden and the Netherlands. For women who do not want to give birth at home a birth centre is a good choice: it leads to similar experiences as a planned hospital birth. Emphasis should be placed on ways to improve autonomy and prompt attention for women who plan to give birth in a birth centre as well as on the improvement of care in case of a referral.
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Affiliation(s)
- Marit Hitzert
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Marieke A A Hermus
- Department of Child Health, TNO, PO Box 2215, 2316 ZL 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
| | - Marisja Scheerhagen
- 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, Wisselweg 33, 1314 CB Almere, The Netherlands
| | - Therese A Wiegers
- NIVEL (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN Utrecht, The Netherlands
| | | | - Paula van Dommelen
- Department of Life Style, TNO, PO Box 2215, 2316 ZL Leiden, The Netherlands
| | | | - Johanna P de Graaf
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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Lanting CI, van Dommelen P, van der Pal-de Bruin KM, Bennebroek Gravenhorst J, van Wouwe JP. Prevalence and pattern of alcohol consumption during pregnancy in the Netherlands. BMC Public Health 2015. [PMID: 26219278 PMCID: PMC4517493 DOI: 10.1186/s12889-015-2070-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective To estimate the prevalence of alcohol consumption during pregnancy in the Netherlands in 2007 and 2010. Method During two identical, nation-wide surveys in 2007 and 2010, questionnaires were handed out to mothers of infants aged ≤6 months who visited a Well-Baby Clinic. By means of the questionnaire mothers were, in addition to questions on infant feeding practices and background variables, asked about their alcohol consumption before, during and after pregnancy. Logistic regression analyses were used to look into relationships of alcohol consumption with maternal and infant characteristics. Results We obtained 2,715 questionnaires in 2007, and 1,410 in 2010. Within 6 months before pregnancy, 69 % of women consumed alcohol (data from 2010). During pregnancy 22 % consumed alcohol in 2007, 19 % in 2010. During the first three months of pregnancy, 17 % (2007) and 14 % (2010) of mothers consumed alcohol. Alcohol consumption was mainly one glass (~10 g alcohol) on less than one occasion per month. Compared to 2007, in 2010 more women consumed 1–3 or >3 glasses alcohol per occasion (resp. 11 % to 7 % and 1.4 to 0.7 %). Older women and those with a higher education consumed more alcohol, as did smokers. Birth weight, gestational age and weight for gestational age were not associated with alcohol consumption. In 2007 and 2010, 2.5 % resp. 2.4 % of pregnant women both smoked and consumed alcohol; resp. 70 % and 75 % did neither. Conclusion In contrast to Dutch guidelines which advice to completely abstain from alcohol, one in five women in the Netherlands consume alcohol during pregnancy.
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Affiliation(s)
- Caren I Lanting
- Departments of Child Health and Life Style, Netherlands Organization for Applied Scientific Research TNO, PO Box 3005, 2301 DA, Leiden, The Netherlands.
| | - Paula van Dommelen
- Departments of Child Health and Life Style, Netherlands Organization for Applied Scientific Research TNO, PO Box 3005, 2301 DA, Leiden, The Netherlands.
| | - Karin M van der Pal-de Bruin
- Departments of Child Health and Life Style, Netherlands Organization for Applied Scientific Research TNO, PO Box 3005, 2301 DA, Leiden, The Netherlands.
| | - Jack Bennebroek Gravenhorst
- Departments of Child Health and Life Style, Netherlands Organization for Applied Scientific Research TNO, PO Box 3005, 2301 DA, Leiden, The Netherlands.
| | - Jacobus P van Wouwe
- Departments of Child Health and Life Style, Netherlands Organization for Applied Scientific Research TNO, PO Box 3005, 2301 DA, Leiden, The Netherlands.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Mohangoo AD, Hukkelhoven CWPM, Achterberg PW, Elferink-Stinkens PM, Ravelli ACJ, Rijninks-van Driel GC, Tamminga P, Waelput AJM, van der Pal-de Bruin KM, Nijhuis JG. [Decline in foetal and neonatal mortality in the Netherlands: comparison with other Euro-Peristat countries between 2004 and 2010]. Ned Tijdschr Geneeskd 2014; 158:A6675. [PMID: 24975973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To compare the change in foetal and neonatal mortality in the Netherlands between 2004 and 2010 with the change in other European countries. DESIGN Descriptive, population-based study. METHOD Data from the Euro-Peristat project on foetal and neonatal mortality in European countries were analysed for changes between 2004 and 2010. The Netherlands was compared with 26 other European countries and regions. International differences in registration and policy were taken into account using figures on foetal mortality starting at 28 weeks of pregnancy and neonatal mortality starting at 24 weeks of pregnancy. RESULTS Foetal mortality in the Netherlands declined by 33%, from 4.3 per 1000 births in 2004 to 2.9 per 1000 births in 2010 while neonatal mortality declined by 21%, from 2.8 per 1000 live births in 2004 to 2.2 per 1000 live births in 2010. Perinatal mortality (the sum of foetal mortality and neonatal mortality) declined by 27%, from 7.0 to 5.1 per 1000. In the European ranking, the Netherlands shifted from 23rd to 13th place for foetal mortality; it remained the same for neonatal mortality (15th of 22 countries) and virtually the same for perinatal mortality (from 15th to 13th of 22 countries). CONCLUSIONS Both foetal mortality at 28+ weeks and neonatal mortality at 24+ weeks declined in the Netherlands between 2004 and 2010. However, the relatively unfavourable position of the Netherlands in the European ranking for foetal and neonatal mortality improved only for foetal mortality. In that respect, the Netherlands holds an average position.
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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: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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van Lunenburg A, van der Pal SM, van Dommelen P, van der Pal-de Bruin KM, Bennebroek Gravenhorst J, Verrips GHW. Changes in quality of life into adulthood after very preterm birth and/or very low birth weight in the Netherlands. Health Qual Life Outcomes 2013; 11:51. [PMID: 23531081 PMCID: PMC3618000 DOI: 10.1186/1477-7525-11-51] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 03/18/2013] [Indexed: 01/22/2023] Open
Abstract
Background It is important to know the impact of Very Preterm (VP) birth or Very Low Birth Weight (VLBW). The purpose of this study is to evaluate changes in Health-Related Quality of Life (HRQoL) of adults born VP or with a VLBW, between age 19 and age 28. Methods The 1983 nationwide Dutch Project On Preterm and Small for gestational age infants (POPS) cohort of 1338 VP (gestational age <32 weeks) or VLBW (<1500 g) infants, was contacted to complete online questionnaires at age 28. In total, 33.8% of eligible participants completed the Health Utilities Index (HUI3), the London Handicap Scale (LHS) and the WHOQoL-BREF. Multiple imputation was applied to correct for missing data and non-response. Results The mean HUI3 and LHS scores did not change significantly from age 19 to age 28. However, after multiple imputation, a significant, though not clinically relevant, increase of 0.02 on the overall HUI3 score was found. The mean HRQoL score measured with the HUI3 increased from 0.83 at age 19 to 0.85 at age 28. The lowest score on the WHOQoL was the psychological domain (74.4). Conclusions Overall, no important changes in HRQoL between age 19 and age 28 were found in the POPS cohort. Psychological and emotional problems stand out, from which recommendation for interventions could be derived.
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Affiliation(s)
- Afra van Lunenburg
- TNO, Child Health, Wassenaarseweg 56, Postbus 2215, Leiden, CE 2301, The Netherlands
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van Gameren-Oosterom HBM, Buitendijk SE, Bilardo CM, van der Pal-de Bruin KM, Van Wouwe JP, Mohangoo AD. Unchanged prevalence of Down syndrome in the Netherlands: results from an 11-year nationwide birth cohort. Prenat Diagn 2012; 32:1035-40. [PMID: 22865545 DOI: 10.1002/pd.3951] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study aims to evaluate trends in prevalence of Down syndrome (DS) births in the Netherlands over an 11-year period and how they have been affected by maternal age and introduction of prenatal screening. METHOD Nationwide data of an 11-year birth cohort (1997-2007) from the Netherlands Perinatal Registry were analyzed. First-trimester combined screening was introduced in 2002, free of charge only for women 36 years of age or older and only on patients' request. Changes in maternal age, prevalence of DS births, and rates of births at <24 weeks (legal limit for termination of pregnancy in the Netherlands) during the study period were evaluated using logistic and linear regression analyses. RESULTS In total, 1,972,058 births were registered (91% of the births in 1997-2007). Mean prevalence of DS was 14.57 per 10,000 births (95% confidence interval 14.43; 14.73); 85% of DS were live births. No significant trend in overall prevalence of DS births was observed (p = 0.385), in spite of a significant increase of mean maternal age during the same period (p < 0.001). The increased prevalence of DS births at ≥ 24 weeks among women ≥ 36 years of age (p = 0.011) was offset by a significant increase in the proportion of DS births at <24 weeks among women aged <36 years (p = 0.013). CONCLUSION The proportion of DS births in the Netherlands has not changed during the period 1997-2007.
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Lanting CI, van Wouwe JPK, van den Burg I, Segaar D, van der Pal-de Bruin KM. [Smoking during pregnancy: trends between 2001 and 2010]. Ned Tijdschr Geneeskd 2012; 156:A5092. [PMID: 23151329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To establish trends in the prevalence of smoking during pregnancy between 2001 and 2010 and to relate these to differences in educational gradient in the Netherlands. DESIGN National surveys. METHOD In 2001, 2002, 2003, 2005, 2007 and 2010, 28,720 questionnaires were handed out to mothers with infants aged up to 6 months at periodic check-ups at well baby clinics. A total of 16,358 (57%) mothers completed this questionnaire. RESULTS Between 2001 and 2010, the number of women who smoked daily during their pregnancy dropped by half. In 2010 6.3% (95% CI: 5.0-7.6) smoked. The prevalence of smoking was highest among mothers with a low level of education (13.8% in 2010; 95% CI 9.3-18.4%) and lowest among mothers with a high level of education (2.4% in 2010; 95% CI 1.2-3.6). Four percent of pregnant smokers stopped smoking during pregnancy. Women limited the median number of ten cigarettes per day during the six months prior to pregnancy to five per day during pregnancy. The difference in prevalence of smoking in pregnancy between women with a low level of education and those with a high level of education was 18.9% in 2001 and 11.4% in 2010. The difference in smoking prevalence between mothers with an average level of education and mothers with a higher level education was 6.5% in 2001 and 5.4% in 2010. CONCLUSION Between 2001 and 2010, the percentage of women who smoked throughout pregnancy dropped by half. In 2010, 6.3% of Dutch pregnant women were still smoking. The prevalence of smoking differed strongly between different levels of education and this difference did not change during the study.
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Anthony S, Jacobusse GW, van der Pal-de Bruin KM, Buitendijk S, Zeitlin J. Do differences in maternal age, parity and multiple births explain variations in fetal and neonatal mortality rates in Europe?--Results from the EURO-PERISTAT project. Paediatr Perinat Epidemiol 2009; 23:292-300. [PMID: 19523076 DOI: 10.1111/j.1365-3016.2009.01044.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Perinatal mortality rates differ markedly between countries in Europe. If population characteristics, such as maternal age, parity or multiple births, contribute to these differences, standardised rates may be useful for international comparisons of health status and especially quality of care. This analysis used aggregated population-based data on fetal and neonatal mortality stratified by maternal age, parity and multiple birth from 12 countries participating in the EURO-PERISTAT project to explore this question. Adjusted odds ratios were computed for fetal and neonatal mortality and tested for inter-country heterogeneity; standardised mortality rates were calculated using a direct standardisation method. There were wide variations in fetal and neonatal mortality rates, from 3.3 to 7.1 and 2.0 to 6.0 per 1000 total and livebirths, respectively, and in the prevalence of mothers over 35 (7-22%), primiparae (41-50%) and multiple births (2-4%). These population characteristics had a significant association with mortality, although results were less consistent for primiparity. Odds ratios for older mothers and primiparae showed significant inter-country heterogeneity. The association between maternal age and fetal mortality declined as the prevalence of older mothers in the population increased. Standardised rates did not substantially change inter-country rankings and demographic characteristics did not explain the higher mortality observed in some countries. Our results do not support the use of mortality rates standardised for age, parity and multiple births for international comparisons of quality of care. Further research should explore why the negative effects of older maternal age decrease as delayed childbearing becomes more common and, in particular, whether this is due to changes in the social characteristics of older mothers or in health care provision.
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Affiliation(s)
- Sabine Anthony
- TNO Quality of Life, Department of Reproduction and Perinatology, Leiden, the Netherlands
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Elsinga J, de Jong-Potjer LC, van der Pal-de Bruin KM, le Cessie S, Assendelft WJ, Buitendijk SE. The Effect of Preconception Counselling on Lifestyle and Other Behaviour Before and During Pregnancy. Womens Health Issues 2008; 18:S117-25. [DOI: 10.1016/j.whi.2008.09.003] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Revised: 09/09/2008] [Accepted: 09/09/2008] [Indexed: 11/25/2022]
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van der Pal-de Bruin KM, le Cessie S, Elsinga J, de Jong-Potjer LC, van Haeringen A, Neven AK, Verloove-Vanhorick SP, Assendelft P. Pre-conception counselling in primary care: prevalence of risk factors among couples contemplating pregnancy. Paediatr Perinat Epidemiol 2008; 22:280-7. [PMID: 18426523 DOI: 10.1111/j.1365-3016.2008.00930.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The outcome of pregnancy can be influenced by several risk factors. Women who are informed about these risks during pre-conception counselling (PCC) have an opportunity to take preventive measures in time. Several studies have shown that high-risk populations have a high prevalence of such risk factors. However, prevalence in the general population, which is assumed to be low risk, is largely unknown. We therefore provided a systematic programme of PCC for the general population and studied the prevalence of risk factors using the risk-assessment questionnaire which was part of the PCC. None of the couples reported no risk factors at all and only 2% of the couples reported risk factors for which written information was considered to be sufficient. Therefore, 98% of all couples reported one or more risk factors for which at least personal counselling by a general practitioner (GP) was indicated. Many of these factors were related to an unhealthy lifestyle. Women with a low level of education reported more risk factors than women with a high level of education. There is a great need for PCC as shown by the fact that almost all couples reported risk factors for which personal counselling was indicated. Pre-conception counselling may reduce the risk of adverse pregnancy outcome by enabling couples to avoid these risks. PCC can be provided by GPs, who have the necessary medical knowledge and background information to counsel couples who wish to have a baby.
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Affiliation(s)
- Karin M van der Pal-de Bruin
- TNO Quality of Life, Division of Child Health, Prevention and Physical Activity, Leiden University Medical Centre, Leiden, The Netherlands
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Lumey LH, Stein AD, Kahn HS, van der Pal-de Bruin KM, Blauw GJ, Zybert PA, Susser ES. Cohort Profile: The Dutch Hunger Winter Families Study. Int J Epidemiol 2007; 36:1196-204. [PMID: 17591638 DOI: 10.1093/ije/dym126] [Citation(s) in RCA: 192] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L H Lumey
- Department of Epidemiology Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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van der Pal-de Bruin KM, de Walle HEK, de Rover CM, Jeeninga W, Cornel MC, de Jong-van den Berg LTW, Buitendijk SE, Paulussen TGWM. Influence of educational level on determinants of folic acid use. Paediatr Perinat Epidemiol 2003; 17:256-63. [PMID: 12839537 DOI: 10.1046/j.1365-3016.2003.00497.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In The Netherlands, periconceptional folic acid use to prevent neural tube defects was promoted through a national 'Folic Acid Campaign'. In two regions, a local campaign supplemented the national campaign to increase the chances of reaching women with low socio-economic status (SES). A framework of outcome criteria, defined as awareness knowledge, perceived safety, attitudes and subjective norms, was developed to evaluate the effectiveness of the two local campaigns. Data were gathered by means of two cross-sectional studies conducted just before and 1 year after the campaigns took place. Before the campaigns were conducted, there were already differences in all effect criteria and folic acid use between women of different educational levels, mostly in favour of women with a high level of education. Although both educational campaigns appeared to have a positive impact on all outcome criteria, they failed to reduce the existing differences in these outcome criteria between women of different educational levels. Folic acid use can be promoted effectively by mass media campaigns, certainly in a large group of women with no prior knowledge of the health benefits associated with periconceptional folic acid use. However, in order to achieve more equal health outcomes among women of low and high SES, it seems that more tailored interventions for women of low SES are needed.
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van der Pal-de Bruin KM, van der Heijden PGM, Buitendijk SE, den Ouden AL. Periconceptional folic acid use and the prevalence of neural tube defects in The Netherlands. Eur J Obstet Gynecol Reprod Biol 2003; 108:33-9. [PMID: 12694967 DOI: 10.1016/s0301-2115(02)00362-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To study the effect of increased folic acid intake on the prevalence of neural tube defects (NTD) in The Netherlands. STUDY DESIGN Using the capture-recapture method, the prevalence of NTD was estimated on the basis of five different registries on births affected by NTD. RESULTS Total prevalence over the 1988-1998 period varied between 1.43 and 1.96 per 1000 live and still births. No decrease in total prevalence was found to have taken place during that period. Scrutiny of the last 2 years, 1997 and 1998, in which increased folic acid intake might be expected to have had an effect, did not give any indication that the prevalence of NTD was falling. CONCLUSIONS A decrease in the Dutch prevalence of NTD during the study period could not be demonstrated due to the relatively small number of women using folic acid periconceptionally. This does not mean automatically that periconceptional folic acid use is ineffective in reducing the Dutch prevalence of NTD. Further monitoring is needed.
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Abstract
OBJECTIVE The purpose of this study was to assess the association between fetal sex and the occurrence of fetal distress during labor. STUDY DESIGN This was a prospective cohort study that incorporated data about 423,033 singleton pregnancies from the national perinatal database for secondary obstetric care in The Netherlands. All singleton pregnancies on record that were delivered under the responsibility of obstetricians in The Netherlands between January 1, 1990, and December 31, 1994, were analyzed. Data about fetal sex, gestational age at delivery, birth weight, fetal distress during labor, mode of delivery, signs of asphyxia at birth, and perinatal death were collected. The associations between sex and the occurrence of operative delivery for fetal distress, low 5-minute Apgar score (score, 0-3), and perinatal death were evaluated by logistic regression analysis. RESULTS Male fetuses are at increased risk for fetal distress during labor, for low Apgar scores, and for perinatal death. After adjustment for fetal birth weight and gestational age at delivery, the odds ratios were 1.48, 1.27, and 1.27, respectively. All three associations were highly statistically significant (P <.0001). CONCLUSION Male fetuses are at increased risk during labor and delivery.
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Affiliation(s)
- Dick J Bekedam
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
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