Intrapartum and neonatal mortality among low-risk women in midwife-led versus obstetrician-led care in the Amsterdam region of the Netherlands: A propensity score matched study

Melanie M.J. Wiegerinck; Birgit Y. Van Der Goes; Anita C.J. Ravelli; Joris A.M. Van Der Post; Fayette C.D. Buist; Pieter Tamminga; Ben W. Mol

doi:10.1136/bmjopen-2017-018845

Intrapartum and neonatal mortality among low-risk women in midwife-led versus obstetrician-led care in the Amsterdam region of the Netherlands: A propensity score matched study

Melanie M.J. Wiegerinck^* (Corresponding Author)
, Birgit Y. Van Der Goes
, Anita C.J. Ravelli
, Joris A.M. Van Der Post
, Fayette C.D. Buist
, Pieter Tamminga
, Ben W. Mol

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

7 Citations (Scopus)

6 Downloads (Pure)

Abstract

Objective To compare intrapartum and neonatal mortality in low-risk term women starting labour in midwife-led versus obstetrician-led care. Study design We performed a propensity score matched study using data from our national perinatal register, completed with data from medical files. We studied women without major risk factors with singleton pregnancies who gave birth at term between 2005 and 2008 in the Amsterdam region of the Netherlands. Major risk factors comprised non-vertex position of the fetus, previous Caesarean birth, hypertension, (gestational) diabetes mellitus, post-term pregnancy (≥42 weeks), prolonged rupture of membranes (>24 hours), vaginal bleeding in the second half of pregnancy or induced labour. Groups were devided by midwife-led versus obstetrician-led care at the onset of labour. The primary outcome was intrapartum and neonatal (<28 days) mortality. Secondary outcomes included obstetric interventions, 5 min Apgar scores<7 and neonatal intensive care admittance for >24 hours. Results We studied 57 396 women. Perinatal mortality occurred in 30 of 46 764 (0.64‰) women in midwife-led care and in 2 of 10 632 (0.19‰) women in obstetrician-led care (OR 3.4, 95% CI 0.82 to 14.3). A propensity score matched analysis in a 1:1 ratio with 10 632 women per group revealed an OR for perinatal mortality of 4.0 (95% CI 0.85 to 18.9). Conclusion Among low-risk women, midwife-led care at the onset of labour was associated with a statistically non-significant higher mortality rate.

Original language	English
Article number	e018845
Pages (from-to)	1-9
Number of pages	9
Journal	BMJ Open
Volume	8
Issue number	1
Early online date	5 Jan 2018
DOIs	https://doi.org/10.1136/bmjopen-2017-018845
Publication status	Published - 5 Jan 2018

Bibliographical note

BWM is supported by a NHMRC Practitioner Fellowship (GNT1082548).

Data Availability Statement

Information regarding our additional analyses can be found in online supplementary appendix A1. These were analyses based on a random sample to validate our denominator.

Funding

Contributors All authors (MMJW, BYvdG, ACJR, FCDB, JAMvdP, PT and BWM) contributed to the realisation of the protocol. ACJR and MW collected all data from the PRN database. MW and BYvdG retrieved additional data from hospitals and midwife practices. BYvdG, FCDB, MMJW, JAMvdP and BWM formed teams of professionals together with three midwives in primary care and an additional perinatologist, and selected cases for inclusion. They also reviewed all 100 cases for the validity check. Data analysis was done by MMJW and ACJR. Paper was written by MMJW in close collaboration with BWM, JAMvdP, ACJR and BYvdG. All authors approved the final manuscript. Funding BWM is supported by a NHMRC Practitioner Fellowship (GNT1082548). Competing interests None declared.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

home birth
intrapartum mortality
low risk
midwifery
neonatal mortality
perinatal mortality

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Cite this

Wiegerinck, M. M. J., Van Der Goes, B. Y., Ravelli, A. C. J., Van Der Post, J. A. M., Buist, F. C. D., Tamminga, P., & Mol, B. W. (2018). Intrapartum and neonatal mortality among low-risk women in midwife-led versus obstetrician-led care in the Amsterdam region of the Netherlands: A propensity score matched study. BMJ Open, 8(1), 1-9. Article e018845. https://doi.org/10.1136/bmjopen-2017-018845

Intrapartum and neonatal mortality among low-risk women in midwife-led versus obstetrician-led care in the Amsterdam region of the Netherlands: A propensity score matched study. / Wiegerinck, Melanie M.J. (Corresponding Author); Van Der Goes, Birgit Y.; Ravelli, Anita C.J. et al.
In: BMJ Open, Vol. 8, No. 1, e018845, 05.01.2018, p. 1-9.

Research output: Contribution to journal › Article › peer-review

Wiegerinck, MMJ, Van Der Goes, BY, Ravelli, ACJ, Van Der Post, JAM, Buist, FCD, Tamminga, P & Mol, BW 2018, 'Intrapartum and neonatal mortality among low-risk women in midwife-led versus obstetrician-led care in the Amsterdam region of the Netherlands: A propensity score matched study', BMJ Open, vol. 8, no. 1, e018845, pp. 1-9. https://doi.org/10.1136/bmjopen-2017-018845

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title = "Intrapartum and neonatal mortality among low-risk women in midwife-led versus obstetrician-led care in the Amsterdam region of the Netherlands: A propensity score matched study",

abstract = "Objective To compare intrapartum and neonatal mortality in low-risk term women starting labour in midwife-led versus obstetrician-led care. Study design We performed a propensity score matched study using data from our national perinatal register, completed with data from medical files. We studied women without major risk factors with singleton pregnancies who gave birth at term between 2005 and 2008 in the Amsterdam region of the Netherlands. Major risk factors comprised non-vertex position of the fetus, previous Caesarean birth, hypertension, (gestational) diabetes mellitus, post-term pregnancy (≥42 weeks), prolonged rupture of membranes (>24 hours), vaginal bleeding in the second half of pregnancy or induced labour. Groups were devided by midwife-led versus obstetrician-led care at the onset of labour. The primary outcome was intrapartum and neonatal (<28 days) mortality. Secondary outcomes included obstetric interventions, 5 min Apgar scores<7 and neonatal intensive care admittance for >24 hours. Results We studied 57 396 women. Perinatal mortality occurred in 30 of 46 764 (0.64‰) women in midwife-led care and in 2 of 10 632 (0.19‰) women in obstetrician-led care (OR 3.4, 95\% CI 0.82 to 14.3). A propensity score matched analysis in a 1:1 ratio with 10 632 women per group revealed an OR for perinatal mortality of 4.0 (95\% CI 0.85 to 18.9). Conclusion Among low-risk women, midwife-led care at the onset of labour was associated with a statistically non-significant higher mortality rate.",

keywords = "home birth, intrapartum mortality, low risk, midwifery, neonatal mortality, perinatal mortality",

author = "Wiegerinck, \{Melanie M.J.\} and \{Van Der Goes\}, \{Birgit Y.\} and Ravelli, \{Anita C.J.\} and \{Van Der Post\}, \{Joris A.M.\} and Buist, \{Fayette C.D.\} and Pieter Tamminga and Mol, \{Ben W.\}",

note = "BWM is supported by a NHMRC Practitioner Fellowship (GNT1082548).",

year = "2018",

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day = "5",

doi = "10.1136/bmjopen-2017-018845",

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T1 - Intrapartum and neonatal mortality among low-risk women in midwife-led versus obstetrician-led care in the Amsterdam region of the Netherlands

T2 - A propensity score matched study

AU - Wiegerinck, Melanie M.J.

AU - Van Der Goes, Birgit Y.

AU - Ravelli, Anita C.J.

AU - Van Der Post, Joris A.M.

AU - Buist, Fayette C.D.

AU - Tamminga, Pieter

AU - Mol, Ben W.

N1 - BWM is supported by a NHMRC Practitioner Fellowship (GNT1082548).

PY - 2018/1/5

Y1 - 2018/1/5

N2 - Objective To compare intrapartum and neonatal mortality in low-risk term women starting labour in midwife-led versus obstetrician-led care. Study design We performed a propensity score matched study using data from our national perinatal register, completed with data from medical files. We studied women without major risk factors with singleton pregnancies who gave birth at term between 2005 and 2008 in the Amsterdam region of the Netherlands. Major risk factors comprised non-vertex position of the fetus, previous Caesarean birth, hypertension, (gestational) diabetes mellitus, post-term pregnancy (≥42 weeks), prolonged rupture of membranes (>24 hours), vaginal bleeding in the second half of pregnancy or induced labour. Groups were devided by midwife-led versus obstetrician-led care at the onset of labour. The primary outcome was intrapartum and neonatal (<28 days) mortality. Secondary outcomes included obstetric interventions, 5 min Apgar scores<7 and neonatal intensive care admittance for >24 hours. Results We studied 57 396 women. Perinatal mortality occurred in 30 of 46 764 (0.64‰) women in midwife-led care and in 2 of 10 632 (0.19‰) women in obstetrician-led care (OR 3.4, 95% CI 0.82 to 14.3). A propensity score matched analysis in a 1:1 ratio with 10 632 women per group revealed an OR for perinatal mortality of 4.0 (95% CI 0.85 to 18.9). Conclusion Among low-risk women, midwife-led care at the onset of labour was associated with a statistically non-significant higher mortality rate.

AB - Objective To compare intrapartum and neonatal mortality in low-risk term women starting labour in midwife-led versus obstetrician-led care. Study design We performed a propensity score matched study using data from our national perinatal register, completed with data from medical files. We studied women without major risk factors with singleton pregnancies who gave birth at term between 2005 and 2008 in the Amsterdam region of the Netherlands. Major risk factors comprised non-vertex position of the fetus, previous Caesarean birth, hypertension, (gestational) diabetes mellitus, post-term pregnancy (≥42 weeks), prolonged rupture of membranes (>24 hours), vaginal bleeding in the second half of pregnancy or induced labour. Groups were devided by midwife-led versus obstetrician-led care at the onset of labour. The primary outcome was intrapartum and neonatal (<28 days) mortality. Secondary outcomes included obstetric interventions, 5 min Apgar scores<7 and neonatal intensive care admittance for >24 hours. Results We studied 57 396 women. Perinatal mortality occurred in 30 of 46 764 (0.64‰) women in midwife-led care and in 2 of 10 632 (0.19‰) women in obstetrician-led care (OR 3.4, 95% CI 0.82 to 14.3). A propensity score matched analysis in a 1:1 ratio with 10 632 women per group revealed an OR for perinatal mortality of 4.0 (95% CI 0.85 to 18.9). Conclusion Among low-risk women, midwife-led care at the onset of labour was associated with a statistically non-significant higher mortality rate.

KW - home birth

KW - intrapartum mortality

KW - low risk

KW - midwifery

KW - neonatal mortality

KW - perinatal mortality

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SN - 2044-6055

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Intrapartum and neonatal mortality among low-risk women in midwife-led versus obstetrician-led care in the Amsterdam region of the Netherlands: A propensity score matched study

Abstract

Bibliographical note

Data Availability Statement

Funding

UN SDGs

Keywords

Access to Document

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