Cover Page
The handle http://hdl.handle.net/1887/66033 holds various files of this Leiden University
dissertation.
Author: Klapwijk-Hermus, M.A.A.
Title: Birth Centre Care in the Netherlands: added value?!
Issue Date: 2018-09-26
General Introduc tion
Chapter 01
12 Chapter 1
Background
Abroad the Netherlands is known for its high percentages of women who give birth at home. Over the last couple of years this trend is changing: the number of people who plan to give birth at home has been decreasing rapidly: In 2015, 15.7 % of all births in the Netherlands took place at home compared to 30.3 % in 2000 [1]. Several different reasons can be thought of to explain this. It may be the result of changing attitudes of Dutch women but also the media attention given to the outcome of the Peristat report in 2008 contributed to this change [2,3]. Also, more and more low risk women are opting for a hospital birth, because they do not feel safe at home, or are asking for referral to receive medication for pain relief that cannot be given in primary care [4]. This all led to an increase of number of women who needed an accommodation near or in a hospital to give birth.
In the last decade an unknown number of birth centres have been instituted in the Netherlands. Internationally birth centres are regarded as settings where women with uncomplicated pregnancies can give birth, assisted by a midwife. In case of a complication or when there is a need for pain relief, the women will be referred to secondary care [5–9]. In the Netherlands a clear definition of ‘birth centre is lacking’. Studies on birth centre care in other countries showed that low risk women who planned to give birth in a birth centre experienced significantly fewer interventions (including intra partum caesarean sections, use of obstetric analgesia and augmentation of labour) compared to women who planned to give birth in a conventional labour setting [6,7,11–13].
The Birthplace study in England showed that adverse perinatal outcomes were not significantly different for low risk nulliparous women who planned birth in freestanding midwifery units and alongside midwifery units compared with planned birth in an obstetric unit. For multiparous women, birth in freestanding and alongside midwifery units significantly and substantially reduced the odds of experiencing an unplanned caesarean section, instrumental birth or episiotomy. No significant differences in adverse perinatal outcomes were found between planned home births or midwifery unit births
14 Chapter 1
Research objec tives
The Dutch Birth Centre Study is designed to evaluate the performance of birth centres and their possible added value to the quality of the Dutch maternity care. The study was funded by ZonMw (the Netherlands Organization for Health Research and Development) in the context of the research program Pregnancy and Childbirth. This program contributes to the reduction of preventable perinatal mortality and morbidity through applied research conducted within regional consortia and through national research.
Evaluation of birth centres was a national theme within this program, prioritized by the Minister of Health. This national study presents evidence-based recommendations for organization and functioning of future birth centres. The study was performed by a unique collaboration of research institutes and universities: Jan van Es Institute, NIVEL, TNO, University Medical Centre Utrecht, Erasmus University Medical Centre, Leiden University Medical Centre, and Tilburg University. The research in this thesis is mostly based on data derived from the Dutch Birth Centre Study.
The aim of this thesis was to study the effect of a planned place of birth in a birth centre on perinatal outcomes, costs and experiences of clients and caregivers. Therefore, first all Dutch birth centres needed to be identified and a combined perinatal outcome measurement tool needed to be adapted to the Dutch situation.
Research Questions
The following research questions are addressed in this thesis:
1) What is the definition of birth centres in the Netherlands and how can these birth centres, as identified based on this definition, be characterised?
2) What is the effect of planned place of birth in a birth centre on
a. the Optimality Index-NL 2015, an outcome index that focuses on optimal instead of adverse outcomes?
b. Costs in relation to outcomes (the Optimality Index-NL 2015)?
c. Transfer during birth and the chances on referral?
d. Experiences of women?
3) Does working with a birth centre influence the job satisfaction of maternity care providers?
Figure 1 • Overview thesis
Outline of Thesis
Chapter 2 includes the study design of the Dutch Birth Centre Study, on which most of the studies in this thesis are based. The Dutch Birth Centre Study consists of five sub studies who are linked to one another. This thesis is one of the three theses based on data from this research.
Chapter 3 describes the formulation of a definition for Dutch birth centres and the
BIRTH CENTRES IN THE NETHERLANDS
Definition, identification and
characteristics
OUTCOMES
Cost-effectiveness Effectiveness (Optimality Index-
NL 2015)
Transfer and referral
Experiences of women
Job satisfaction of maternity care
providers Development of
Optimality Index - NL 2015
16 Chapter 1
Chapter 7 describes the process of transfer of nulliparous women who plan to give birth in a birth centre during and after childbirth. Also the effect of a vaginal examination at home prior to the voluntary transfer from home to the birth centre is discussed. (Q2c) In Chapter 8 the experiences of women who planned birth in a birth centre are compared to women who planned birth at home or at the hospital. The women who actually arrived at the birth centre were also asked about their experiences with the birth centre and its facilities and services. (Q2d)
Chapter 9 describes the job satisfaction for different maternity care providers working in or with a birth centre or in a different setting. (Q3)
Chapter 10 represents an overview of the main findings of this thesis and a reflection on its findings. It also describes the implications for practice and research.
References
1 Perined. Perinatale Zorg in Nederland 2015. Utrecht: 2016.
2 de Vries R. A pleasing birth. Amsterdam University Press 2005.
3 Mohangoo AD, Buitendijk SE, Szamotulska K, et al. Gestational age patterns of fetal and neonatal mortality in Europe: results from the Euro-Peristat project. PLoS One 2011;6:e24727. doi:10.1371/journal.
pone.0024727
4 Offerhaus PM, Hukkelhoven CWPM, de Jonge A, et al. Persisting rise in referrals during labor in primary midwife-led care in The Netherlands. Birth 2013;40:192–201. doi:10.1111/birt.12055
5 Laws PJ, Lim C, Tracy S, et al. Characteristics and practices of birth centres in Australia. Aust N Z J Obstet Gynaecol 2009;49:290–5. doi:10.1111/j.1479-828X.2009.01002.x
6 Brocklehurst P, Hardy P, Hollowell J, et al. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study.
BMJ 2011;343:d7400. doi:10.1136/bmj.d7400
7 Stewart M, Mccandlish R, Henderson J, et al. Review of evidence about clinical , psychosocial and economic outcomes for women with straightforward pregnancies who plan to give birth in a midwife-led birth centre , and outcomes for their babies . Report of a structured review of birth centre outcomes. Oxford: 2005.
8 AABC. Definition of Birth Center. http://www.birthcenters.org/news/344953/Definition-of-Birth-Center- Clarified.htm (accessed 15 Apr2013).
9 Rowe R. Birthplace terms and definitions: consensus process Birthplace in England research programme.
Final report part 2. 2011. http://openaccess.city.ac.uk/3651/1/Birthplace definitions rpt SDO_FR2_08- 1604-140_V02.pdf (accessed 15 Jun2013).
10 Laws PJ, Tracy SK, Sullivan E a. Perinatal outcomes of women intending to give birth in birth centers in Australia. Birth 2010;37:28–36. doi:10.1111/j.1523-536X.2009.00375.x
11 Hodnett E, Downe S, Walsh D, et al. Alternative versus conventional institutional settings for birth ( Review ). Cochrane Database Syst Rev 2010;:Art. No.: CD000012. DOI: 10.1002/14651858.CD000012.
http://www.cochrane.org/CD000012/PREG_alternative-versus-conventional-institutional-settings-for- birth
12 Waldenström U, Nilsson CA, Winbladh B. The Stockholm birth centre trial: maternal and infant outcome.
Br J Obstet Gynaecol 1997;104:410–8.http://www.ncbi.nlm.nih.gov/pubmed/9141576 (accessed 30 Sep2017).
13 Wiegers TA, Keirse MJ, van der Zee J, et al. Outcome of planned home and planned hospital births in low risk pregnancies: Prospective study in midwifery practices in the Netherlands. Bmj 1996;313:1309–13.
doi:10.1136/bmj.313.7068.1309
14 De Jonge A, Van Der Goes BY, Ravelli ACJ, et al. Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births. BJOG An Int J Obstet Gynaecol 2009;116:1177–84.
doi:10.1111/j.1471-0528.2009.02175.x
15 van Der Hulst LAM, van Teijlingen ER, Bonsel GJ, et al. Does a pregnant woman’s intended place of birth
