Title
Women's characteristics and care outcomes of caseload midwifery care in the Netherlands: a retrospective cohort study
Author
Offerhaus, P.
Jans, S
Hukkelhoven, C.
de Vries, R.
Nieuwenhuijze, M.
Publication year
2020
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.
Subject
Birth outcomes
Caseload midwifery
Continuity of care
Primary health care
Women's characteristics
Adult
Apgar score
Cohort analysis
Controlled study
Female
Human
Human experiment
Incidence
Major clinical study
Maternal age
Maternal care
Midwife
Multipara
Netherlands
Nullipara
Obstetrician
Outcome assessment
Patient referral
Perinatal mortality
Perineum
Pregnancy outcome
Prenatal care
Retrospective study
Vaginal delivery
Healthy for Life
Healthy Living
Life
CH - Child Health
ELSS - Earth, Life and Social Sciences
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http://resolver.tudelft.nl/uuid:bb012f6c-a440-4a5b-ada0-92eb4278840f
DOI
https://doi.org/10.1186/s12884-020-03204-3
TNO identifier
880281
Source
BMC Pregnancy Childbirth, 20 (20)
Document type
article