Effect of planned place of birth on obstetric interventions and maternal outcomes among low-risk women: a cohort study in the Netherlands

Abstract

BackgroundThe use of interventions in childbirth has increased the past decades. There is concern that some women might receive more interventions than they really need. For low-risk women, midwife-led birth settings may be of importance as a counterbalance towards the increasing rate of interventions. The effect of planned place of birth on interventions in the Netherlands is not yet clear. This study aims to give insight into differences in obstetric interventions and maternal outcomes for planned home versus planned hospital birth among women in midwife-led care.MethodsWomen from twenty practices across the Netherlands were included in 2009 and 2010. Of these, 3495 were low-risk and in midwife-led care at the onset of labour. Information about planned place of birth and outcomes, including instrumental birth (caesarean section, vacuum or forceps birth), labour augmentation, episiotomy, oxytocin in third stage, postpartum haemorrhage >1000 ml and perineal damage, came from the national midwife-led care perinatal database, and a postpartum questionnaire.ResultsWomen who planned home birth more often had spontaneous birth (nulliparous women aOR 1.38, 95 % CI 1.08–1.76, parous women aOR 2.29, 95 % CI 1.21–4.36) and less often episiotomy (nulliparous women aOR 0.73, 0.58–0.91, parous women aOR 0.47, 0.33–0.68) and use of oxytocin in the third stage (nulliparous women aOR 0.58, 0.42–0.80, parous women aOR 0.47, 0.37–0.60) compared to women who planned hospital birth. Nulliparous women more often had anal sphincter damage (aOR 1.75, 1.01–3.03), but the difference was not statistically significant if women who had caesarean sections were excluded. Parous women less often had labour augmentation (aOR 0.55, 0.36–0.82) and more often an intact perineum (aOR 1.65, 1.34–2.03). There were no differences in rates of vacuum/forceps birth, unplanned caesarean section and postpartum haemorrhage >1000 ml.ConclusionsWomen who planned home birth were more likely to give birth spontaneously and had fewer medical interventions.

Pregnancy related anxiety and general anxious or depressed mood and the choice for birth setting: a secondary data-analysis of the DELIVER study

“…In the Netherlands, no increased rates of mortality or morbidity among parous and nulliparous low risk women were found among planned home births compared to planned midwife-led hospital births [16–18]. There is evidence to suggest that low risk women who plan a home birth have a lower risk of obstetric interventions, and a higher chance to give birth spontaneously [19, 20]. Increased risk of interventions in a hospital birth setting is reflected in costs as well.…”

Planned home birth in Slovenia—Are we ready?

“…There was no difference in urgent caesarean section or vacuum extraction and haemorrhage greater than 1000 mL among the women giving birth at home. 10 TAKA c ET AL. 1962 e Studies evaluating the well-being of the newborns after home birth show less favourable neonatal outcomes when comparing planned home births with hospital births according to neonatal outcome measures such as Apgar score, neonatal seizures, and neonatal intensive care unit (NICU) admissions.…”

“…There was also a lower need to use oxytocin in the third stage of labour (81% vs 62.6%) in parous women compared with that in nulliparous women. There was no difference in urgent caesarean section or vacuum extraction and haemorrhage greater than 1000 mL among the women giving birth at home …”

Methodology for sampling women at high maternal risk in administrative data

“…[1][2][3] Clinical guidelines, though useful in practice, may not be appropriate for research sample selection because they 1) do not differentiate 3 between maternal and fetal risk, 2) focus on identifying women at low risk rather than defining high maternal risk, and 3) rely on clinical information not available in administrative data. 4,5 We were concerned that any conventional sample selection method we used would overestimate the clinical maternal risk, causing misclassification bias in our study.…”