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Harmsen van der Vliet-Torij HW, Bertens LCM, Ochoa LB, Gouman MJBM, Posthumus AG, Steegers EAP. Type of deliveries supported by Dutch clinical midwives. Midwifery 2023; 124:103744. [PMID: 37271066 DOI: 10.1016/j.midw.2023.103744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/04/2023] [Accepted: 05/23/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The number of clinical midwives in the Netherlands has substantially increased over the last twenty years, but their role in obstetric care is not clearly defined. Our aim was to identify the type of deliveries that are usually supported by clinical midwives and whether these changed over time. DESIGN, SETTING, AND PARTICIPANTS National data from the Netherlands Perinatal Registry from the years 2000 to 2016 (n = 2.999.411 deliveries) were used to divide all deliveries into classes using latent class analyses based on delivery characteristics. In the primary analyses, the identified classes, type of hospital, and year of cohort were used to predict deliveries supported by a clinical midwife. In secondary analyses, the same analyses were repeated where the classes were replaced by individual level characteristics of deliveries and stratified by referral during birth. MEASUREMENTS AND FINDINGS The latent class analyses identified three classes: I. referral during birth; II. Induction of labour; and III. Planned caesarian section. The primary analyses indicated that women in both class I and II were frequently supported by clinical midwives and those in the third class almost never. Therefore, only data from deliveries assigned to class I and II were used in the secondary analyses. The secondary analyses showed that clinical midwives supported deliveries with a great variety in characteristics, such as pain relief and preterm birth. Although the frequency of clinical midwives being involved in the second stage of labour increased over the years, we did not find noticeable changes in their involvement. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE Clinical midwives care for women with various types of deliveries with varying degrees of pathology and complexity during second stage of labour. Additional training, taking previously acquired skills and competences into account, is necessary to deal with this complexity for which clinical midwives are not always trained.
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Affiliation(s)
- H W Harmsen van der Vliet-Torij
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, Rotterdam 3015 EK, the Netherlands.
| | - L C M Bertens
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, PO Box 2040, Rotterdam 3000 CA, the Netherlands
| | - L Burgos Ochoa
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, PO Box 2040, Rotterdam 3000 CA, the Netherlands
| | - M J B M Gouman
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, Rotterdam 3015 EK, the Netherlands
| | - A G Posthumus
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, PO Box 2040, Rotterdam 3000 CA, the Netherlands
| | - E A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, PO Box 2040, Rotterdam 3000 CA, the Netherlands
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Molenaar JM, van der Meer L, Bertens LCM, de Vries EF, Waelput AJM, Knight M, Steegers EAP, Kiefte-de Jong JC, Struijs JN. Defining vulnerability subgroups among pregnant women using pre-pregnancy information: a latent class analysis. Eur J Public Health 2023; 33:25-34. [PMID: 36515418 PMCID: PMC10263266 DOI: 10.1093/eurpub/ckac170] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Early detection of vulnerability during or before pregnancy can contribute to optimizing the first 1000 days, a crucial period for children's development and health. We aimed to identify classes of vulnerability among pregnant women in the Netherlands using pre-pregnancy data on a wide range of social risk and protective factors, and validate these classes against the risk of adverse outcomes. METHODS We conducted a latent class analysis based on 42 variables derived from nationwide observational data sources and self-reported data. Variables included individual, socioeconomic, lifestyle, psychosocial and household characteristics, self-reported health, healthcare utilization, life-events and living conditions. We compared classes in relation to adverse outcomes using logistic regression analyses. RESULTS In the study population of 4172 women, we identified five latent classes. The largest 'healthy and socioeconomically stable'-class [n = 2040 (48.9%)] mostly shared protective factors, such as paid work and positively perceived health. The classes 'high care utilization' [n = 485 (11.6%)], 'socioeconomic vulnerability' [n = 395 (9.5%)] and 'psychosocial vulnerability' [n = 1005 (24.0%)] were characterized by risk factors limited to one specific domain and protective factors in others. Women classified into the 'multidimensional vulnerability'-class [n = 250 (6.0%)] shared multiple risk factors in different domains (psychosocial, medical and socioeconomic risk factors). Multidimensional vulnerability was associated with adverse outcomes, such as premature birth and caesarean section. CONCLUSIONS Co-existence of multiple risk factors in various domains is associated with adverse outcomes for mother and child. Early detection of vulnerability and strategies to improve parental health and well-being might benefit from focussing on different domains and combining medical and social care and support.
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Affiliation(s)
- J M Molenaar
- Department of Quality of Care and Health Economics, National Institute for Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, Bilthoven, the Netherlands
- Department of Public Health and Primary Care/Health Campus The Hague, Leiden University Medical Centre, the Hague, the Netherlands
| | - L van der Meer
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - L C M Bertens
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - E F de Vries
- Department of Quality of Care and Health Economics, National Institute for Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, Bilthoven, the Netherlands
- Department of Public Health and Primary Care/Health Campus The Hague, Leiden University Medical Centre, the Hague, the Netherlands
| | - A J M Waelput
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - M Knight
- Department of Public Health and Primary Care/Health Campus The Hague, Leiden University Medical Centre, the Hague, the Netherlands
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - E A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - J C Kiefte-de Jong
- Department of Public Health and Primary Care/Health Campus The Hague, Leiden University Medical Centre, the Hague, the Netherlands
| | - J N Struijs
- Department of Quality of Care and Health Economics, National Institute for Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, Bilthoven, the Netherlands
- Department of Public Health and Primary Care/Health Campus The Hague, Leiden University Medical Centre, the Hague, the Netherlands
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Ochoa LB, Bijlsma MJ, Steegers EAP, Been JV, Bertens LCM. Does neighbourhood crime mediate the relationship between neighbourhood SES and birth outcomes? Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Previous studies have consistently found that women living in low socioeconomic status (SES) neighbourhoods are at higher risk of experiencing adverse birth outcomes compared to women from high SES areas. However, the mechanisms through which neighbourhood SES might influence health at birth remain poorly understood. One of the proposed pathways is the exposure to higher crime rates. The aim of this study is to investigate whether neighbourhood crime mediates the relationship between neighbourhood SES and birth outcomes.
Methods
A retrospective cohort study including over 1.3 million singleton births occurred in the Netherlands between 2010 and 2017. Individual-level data from the Dutch perinatal registry was linked to quintiles of neighbourhood SES scores and neighbourhood-level crime rates. Using the mediational g-formula, we estimated the total effect, natural direct effect, and natural indirect effect of neighbourhood SES on birth outcomes: small-for-gestational-age (SGA), low birth weight, and preterm birth. The neighbourhood SES intervention settings correspond with a hypothetical improvement in neighbourhood SES from the lowest to the highest quintile.
Results
The hypothetical improvement in neighbourhood SES resulted in a 6.6% (CI = 5.6%; 7.5%) relative reduction in the proportion of SGA births, an 8.9% (CI = 7.6%; 10.3%) reduction in the proportion of low birth weight, and a 5.1% (CI = 4.0%; 6.1%) decrease of preterm birth. Neighbourhood crime accounted for 29.0% (CI = 25.1%; 32.8%) of the total effect of neighbourhood SES on SGA, and for 8.6% (CI = 5.1%; 11.6%) of the total effect on low birth weight. For preterm birth, we found no evidence of mediation by neighbourhood crime.
Conclusions
Neighbourhood crime mediates the association between neighbourhood SES and key adverse birth outcomes. Interventions targeted at lowering neighbourhood crime rates could improve birth outcomes in disadvantaged areas.
Key messages
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Affiliation(s)
- L Burgos Ochoa
- Obstetrics and Gyneacology, Erasmus MC , Rotterdam, Netherlands
| | - MJ Bijlsma
- Pharmacotherapy, Epidemiology and Economics, University of Groningen , Groningen, Netherlands
| | - EAP Steegers
- Obstetrics and Gyneacology, Erasmus MC , Rotterdam, Netherlands
| | - JV Been
- Obstetrics and Gyneacology, Erasmus MC , Rotterdam, Netherlands
- Division of Neonatology, Paediatrics, Erasmus MC , Rotterdam, Netherlands
- Department of Public Health, Erasmus MC , Rotterdam, Netherlands
| | - LCM Bertens
- Obstetrics and Gyneacology, Erasmus MC , Rotterdam, Netherlands
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Burgos Ochoa L, Bertens LCM, Steegers EAP, Been JV. High to low, low to high: neighbourhood socioeconomic trajectories and birth outcomes. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
A growing body of literature has consistently linked neighbourhood socioeconomic status (SES) with adverse birth outcomes. However, the available evidence is based on cross-sectional indicators of neighbourhood SES, which fail to reflect neighbourhoods' dynamic nature. The objective of this study was to explore the relationship between temporal trajectories of neighbourhood socioeconomic change and adverse birth outcomes.
Methods
The study population consisted of registered singleton births occurred in the Netherlands 2003-2017 between 24 and 41 weeks of gestation (N = 2,335,449). Based on neighbourhood socioeconomic data from The Netherlands Institute for Social Research, we categorized neighbourhoods into longitudinal SES trajectories (e.g. stable, declining, ascending). Multilevel logistic regression models were used to estimate the relationship between neighbourhood SES trajectories and birth outcomes, i.e., preterm birth and small-for-gestational-age (SGA).
Results
Living in a Stable Low SES neighbourhood was associated with higher odds of preterm birth (OR[CI]=1.10[1.06; 1.14]), and SGA (OR[CI]=1.15[1.12; 1.18]), compared to living in Stable High SES areas. Also, women living in a Declining (Middle to Low SES) neighbourhood had higher odds for preterm birth (OR = 1.08[1.03; 1.14]) and SGA (OR = 1.10 [1.06; 1.15]), compared to Stable High SES areas.
Conclusions
Women from neighbourhoods with long-term low or declining SES were more likely to experience adverse birth outcomes. Policies aimed at mitigating the effect of long-term neighbourhood disadvantage or preventing neighbourhoods' decline have potential to benefit early life health outcomes.
Key messages
Women living in long-term low or declining socioeconomic status neighbourhoods were more likely to experience adverse birth outcomes. Our results can provide guidance to policies aimed at improving early life health outcomes.
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Affiliation(s)
- L Burgos Ochoa
- Obstetrics and Gynaecology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - L C M Bertens
- Obstetrics and Gynaecology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - E A P Steegers
- Obstetrics and Gynaecology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - J V Been
- Obstetrics and Gynaecology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
- Division of Neonatology, Department of Paediatrics, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
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Lagendijk J, Been JV, Ernst-Smelt HE, Bonsel GJ, Bertens LCM, Steegers EAP. Client-tailored maternity care to increase maternal empowerment: cluster randomized controlled trial protocol; the healthy pregnancy 4 All-2 program. BMC Pregnancy Childbirth 2019; 19:4. [PMID: 30606140 PMCID: PMC6318875 DOI: 10.1186/s12884-018-2155-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 12/27/2017] [Accepted: 12/17/2018] [Indexed: 01/01/2023] Open
Abstract
Background The postpartum period is an important period for preventive strategies as common maternal and child health risks may become manifest. Women with a lower socioeconomic status tend to have lower maternal empowerment. Increasing their risks of adverse maternal and child health outcomes. This study aims to assess the effectiveness of a primary care level intervention. Delivered to maternity care assistants, aiming to increase maternal empowerment postpartum. Methods This study is part of the Dutch nationwide “Healthy Pregnancy 4 All-2” (HP4All-2) program, which aims to identify vulnerable mothers and young children at risk of adverse health outcomes, and subsequently improve their care. This program targets women from deprived neighborhoods. A pragmatic cluster randomized controlled trial will be undertaken in 12 maternity care organizations. Maternity care organizations in urban municipalities (i.e. the clusters) will be randomized to either a systematic risk assessment during pregnancy with emphasis on identification of non-medical risk factors for adverse maternal and neonatal health outcomes, and subsequent adaptation of care towards a client-tailored approach during pregnancy and the postpartum period, or solely the systematic risk assessment. The primary outcome is the prevalence of a low maternal empowerment score postpartum. Secondary maternal outcomes cover health-related quality of life, postnatal depression, smoking, alcohol consumption, illicit drug use. Finally, maternal and neonatal health care utilization postpartum are recorded. All outcomes will be analyzed according to the intention-to-treat principle, using multi-level mixed effects models. Discussion The study will contribute to evidence regarding the effectiveness of client-tailored, risk-based maternity care to increase maternal empowerment postpartum. Trial registration Netherlands Trial Registry (NTR) 6311, registered 03-27-2017.
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Affiliation(s)
- J Lagendijk
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - J V Been
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.,Division of Neonatology, Department of Pediatrics, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.,Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - H E Ernst-Smelt
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - G J Bonsel
- Department of Obstetrics and Gynecology, University Medical Centre Utrecht, PO Box 85090, 3508, AB, Utrecht, The Netherlands
| | - L C M Bertens
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - E A P Steegers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
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van der Hulst M, Polinder S, de Groot MW, Kok R, Prinzie P, Steegers EAP, Burdorf A, Bertens LCM. The relation between deprivation and healthcare costs for Dutch children. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky214.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - S Polinder
- Erasmus Medical Center, Rotterdam, Netherlands
| | - MW de Groot
- Erasmus Medical Center, Rotterdam, Netherlands
| | - R Kok
- Erasmus University, Rotterdam, Netherlands
| | - P Prinzie
- Erasmus University, Rotterdam, Netherlands
| | | | - A Burdorf
- Erasmus Medical Center, Rotterdam, Netherlands
| | - LCM Bertens
- Erasmus Medical Center, Rotterdam, Netherlands
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Oosterlaken T, van Deursen P, Jurriaans S, Ligeon V, Bertens L, de Jong J. PV-1 HIV-1 RNA quantification in plasma specimens using nuclisens easyQ HIV-1 V2.0. J Clin Virol 2009. [DOI: 10.1016/s1386-6532(09)70136-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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