Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands: a national quasi-experimental study

B. Y. Gravesteijn; N. Boderie; T. van den Akker; L. C.M. Bertens; K. Bloemenkamp; L. Burgos Ochoa; A. de Jonge; B. M. Kazemier; P. P. Klein; I. Kwint-Reijnders; J. A. Labrecque; B. W. Mol; S. A. Obermann-Borst; L. Peters; A. C.J. Ravelli; A. Schonewille-Rosman; J. Been; C. J. de Groot; E. Ambrosino; K. V. Auweele; R. Beijers; L. C.M. Bertens; N. Boderie; L. Burdorf; L. Burgos Ochoa; C. de Weerth; A. Franx; S. Harper; P. P. Klein; D. Kretz; J. Muris; M. Nieuwenhuijze; S. A. Obermann-Borst; M. Oudijk; L. Ramerman; A. Ravelli; A. Schonewille-Rosman; J. Struijs; H. Torij; M. Van Beukering; M. van den Heuvel; J. van Dillen; F. van Lenthe; T. Van Ourti; A. Verhoeff; M. Vermeulen; N. Visser; S. Willers; S. Schoenmakers; Z. Zainularab

doi:10.1016/j.puhe.2024.06.024

Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands: a national quasi-experimental study

B. Y. Gravesteijn^*, N. Boderie, T. van den Akker, L. C.M. Bertens, K. Bloemenkamp, L. Burgos Ochoa, A. de Jonge, B. M. Kazemier, P. P. Klein, I. Kwint-Reijnders, J. A. Labrecque, B. W. Mol, S. A. Obermann-Borst, L. Peters, A. C.J. Ravelli, A. Schonewille-Rosman, J. Been, C. J. de Groot, E. Ambrosino, K. V. AuweeleR. Beijers, L. C.M. Bertens, N. Boderie, L. Burdorf, L. Burgos Ochoa, C. de Weerth, A. Franx, S. Harper, P. P. Klein, D. Kretz, J. Muris, M. Nieuwenhuijze, S. A. Obermann-Borst, M. Oudijk, L. Ramerman, A. Ravelli, A. Schonewille-Rosman, J. Struijs, H. Torij, M. Van Beukering, M. van den Heuvel, J. van Dillen, F. van Lenthe, T. Van Ourti, A. Verhoeff, M. Vermeulen, N. Visser, S. Willers, S. Schoenmakers, Z. Zainularab

^*Corresponding author for this work

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

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Abstract

OBJECTIVES:

The COVID-19 pandemic and associated lockdowns disrupted health care worldwide. High-income countries observed a decrease in preterm births during lockdowns, but maternal pregnancy-related outcomes were also likely affected. This study investigates the effect of the first COVID-19 lockdown (March-June 2020) on provision of maternity care and maternal pregnancy-related outcomes in the Netherlands.

STUDY DESIGN:

National quasi-experimental study.

METHODS:

Multiple linked national registries were used, and all births from a gestational age of 24+0 weeks in 2010-2020 were included. In births starting in midwife-led primary care, we assessed the effect of lockdown on provision of care. In the general pregnant population, the impact on characteristics of labour and maternal morbidity was assessed. A difference-in-regression-discontinuity design was used to derive causal estimates for the year 2020.

RESULTS:

A total of 1,039,728 births were included. During the lockdown, births to women who started labour in midwife-led primary care (49%) more often ended at home (27% pre-lockdown, +10% [95% confidence interval: +7%, +13%]). A small decrease was seen in referrals towards obstetrician-led care during labour (46%, -3% [-5%,-0%]). In the overall group, no significant change was seen in induction of labour (27%, +1% [-1%, +3%]). We found no significant changes in the incidence of emergency caesarean section (9%, -1% [-2%, +0%]), obstetric anal sphincter injury (2%, +0% [-0%, +1%]), episiotomy (21%, -0% [-2%, +1%]), or post-partum haemorrhage: >1000 ml (6%, -0% [-1%, +1%]).

CONCLUSIONS:

During the first COVID-19 lockdown in the Netherlands, a substantial increase in homebirths was seen. There was no evidence for changed available maternal outcomes, suggesting that a maternity care system with a strong midwife-led primary care system may flexibly and safely adapt to external disruptions.

Original language	English
Pages (from-to)	15-25
Number of pages	11
Journal	Public Health
Volume	235
Early online date	20 Jul 2024
DOIs	https://doi.org/10.1016/j.puhe.2024.06.024
Publication status	Published - Oct 2024

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

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Gravesteijn, B. Y., Boderie, N., van den Akker, T., Bertens, L. C. M., Bloemenkamp, K., Burgos Ochoa, L., de Jonge, A., Kazemier, B. M., Klein, P. P., Kwint-Reijnders, I., Labrecque, J. A., Mol, B. W., Obermann-Borst, S. A., Peters, L., Ravelli, A. C. J., Schonewille-Rosman, A., Been, J., de Groot, C. J., Ambrosino, E., ... Zainularab, Z. (2024). Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands: a national quasi-experimental study. Public Health, 235, 15-25. https://doi.org/10.1016/j.puhe.2024.06.024

@article{bced32c750b84dec8073d72f83bf1588,

title = "Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands: a national quasi-experimental study",

abstract = "OBJECTIVES:The COVID-19 pandemic and associated lockdowns disrupted health care worldwide. High-income countries observed a decrease in preterm births during lockdowns, but maternal pregnancy-related outcomes were also likely affected. This study investigates the effect of the first COVID-19 lockdown (March-June 2020) on provision of maternity care and maternal pregnancy-related outcomes in the Netherlands.STUDY DESIGN: National quasi-experimental study.METHODS: Multiple linked national registries were used, and all births from a gestational age of 24+0 weeks in 2010-2020 were included. In births starting in midwife-led primary care, we assessed the effect of lockdown on provision of care. In the general pregnant population, the impact on characteristics of labour and maternal morbidity was assessed. A difference-in-regression-discontinuity design was used to derive causal estimates for the year 2020.RESULTS: A total of 1,039,728 births were included. During the lockdown, births to women who started labour in midwife-led primary care (49%) more often ended at home (27% pre-lockdown, +10% [95% confidence interval: +7%, +13%]). A small decrease was seen in referrals towards obstetrician-led care during labour (46%, -3% [-5%,-0%]). In the overall group, no significant change was seen in induction of labour (27%, +1% [-1%, +3%]). We found no significant changes in the incidence of emergency caesarean section (9%, -1% [-2%, +0%]), obstetric anal sphincter injury (2%, +0% [-0%, +1%]), episiotomy (21%, -0% [-2%, +1%]), or post-partum haemorrhage: >1000 ml (6%, -0% [-1%, +1%]).CONCLUSIONS: During the first COVID-19 lockdown in the Netherlands, a substantial increase in homebirths was seen. There was no evidence for changed available maternal outcomes, suggesting that a maternity care system with a strong midwife-led primary care system may flexibly and safely adapt to external disruptions.",

author = "Gravesteijn, {B. Y.} and N. Boderie and {van den Akker}, T. and Bertens, {L. C.M.} and K. Bloemenkamp and {Burgos Ochoa}, L. and {de Jonge}, A. and Kazemier, {B. M.} and Klein, {P. P.} and I. Kwint-Reijnders and Labrecque, {J. A.} and Mol, {B. W.} and Obermann-Borst, {S. A.} and L. Peters and Ravelli, {A. C.J.} and A. Schonewille-Rosman and J. Been and {de Groot}, {C. J.} and E. Ambrosino and Auweele, {K. V.} and R. Beijers and Bertens, {L. C.M.} and N. Boderie and L. Burdorf and {Burgos Ochoa}, L. and {de Weerth}, C. and A. Franx and S. Harper and Klein, {P. P.} and D. Kretz and J. Muris and M. Nieuwenhuijze and Obermann-Borst, {S. A.} and M. Oudijk and L. Ramerman and A. Ravelli and A. Schonewille-Rosman and J. Struijs and H. Torij and {Van Beukering}, M. and {van den Heuvel}, M. and {van Dillen}, J. and {van Lenthe}, F. and {Van Ourti}, T. and A. Verhoeff and M. Vermeulen and N. Visser and S. Willers and S. Schoenmakers and Z. Zainularab",

note = "{\textcopyright} 2024 The Author(s). Published by Elsevier Ltd on behalf of The Royal Society for Public Health. ",

year = "2024",

month = oct,

doi = "10.1016/j.puhe.2024.06.024",

language = "English",

volume = "235",

pages = "15--25",

journal = "Public Health",

issn = "0033-3506",

publisher = "Elsevier",

}

Gravesteijn, BY , Boderie, N, van den Akker, T, Bertens, LCM, Bloemenkamp, K, Burgos Ochoa, L, de Jonge, A, Kazemier, BM, Klein, PP, Kwint-Reijnders, I, Labrecque, JA, Mol, BW, Obermann-Borst, SA, Peters, L, Ravelli, ACJ, Schonewille-Rosman, A , Been, J, de Groot, CJ, Ambrosino, E, Auweele, KV, Beijers, R, Bertens, LCM , Boderie, N, Burdorf, L, Burgos Ochoa, L, de Weerth, C, Franx, A, Harper, S, Klein, PP, Kretz, D, Muris, J, Nieuwenhuijze, M, Obermann-Borst, SA, Oudijk, M, Ramerman, L, Ravelli, A, Schonewille-Rosman, A, Struijs, J, Torij, H, Van Beukering, M, van den Heuvel, M, van Dillen, J, van Lenthe, F , Van Ourti, T, Verhoeff, A, Vermeulen, M, Visser, N, Willers, S, Schoenmakers, S & Zainularab, Z 2024, 'Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands: a national quasi-experimental study', Public Health, vol. 235, pp. 15-25. https://doi.org/10.1016/j.puhe.2024.06.024

TY - JOUR

T1 - Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands

T2 - a national quasi-experimental study

AU - Gravesteijn, B. Y.

AU - Boderie, N.

AU - van den Akker, T.

AU - Bertens, L. C.M.

AU - Bloemenkamp, K.

AU - Burgos Ochoa, L.

AU - de Jonge, A.

AU - Kazemier, B. M.

AU - Klein, P. P.

AU - Kwint-Reijnders, I.

AU - Labrecque, J. A.

AU - Mol, B. W.

AU - Obermann-Borst, S. A.

AU - Peters, L.

AU - Ravelli, A. C.J.

AU - Schonewille-Rosman, A.

AU - Been, J.

AU - de Groot, C. J.

AU - Ambrosino, E.

AU - Auweele, K. V.

AU - Beijers, R.

AU - Bertens, L. C.M.

AU - Boderie, N.

AU - Burdorf, L.

AU - Burgos Ochoa, L.

AU - de Weerth, C.

AU - Franx, A.

AU - Harper, S.

AU - Klein, P. P.

AU - Kretz, D.

AU - Muris, J.

AU - Nieuwenhuijze, M.

AU - Obermann-Borst, S. A.

AU - Oudijk, M.

AU - Ramerman, L.

AU - Ravelli, A.

AU - Schonewille-Rosman, A.

AU - Struijs, J.

AU - Torij, H.

AU - Van Beukering, M.

AU - van den Heuvel, M.

AU - van Dillen, J.

AU - van Lenthe, F.

AU - Van Ourti, T.

AU - Verhoeff, A.

AU - Vermeulen, M.

AU - Visser, N.

AU - Willers, S.

AU - Schoenmakers, S.

AU - Zainularab, Z.

PY - 2024/10

Y1 - 2024/10

N2 - OBJECTIVES:The COVID-19 pandemic and associated lockdowns disrupted health care worldwide. High-income countries observed a decrease in preterm births during lockdowns, but maternal pregnancy-related outcomes were also likely affected. This study investigates the effect of the first COVID-19 lockdown (March-June 2020) on provision of maternity care and maternal pregnancy-related outcomes in the Netherlands.STUDY DESIGN: National quasi-experimental study.METHODS: Multiple linked national registries were used, and all births from a gestational age of 24+0 weeks in 2010-2020 were included. In births starting in midwife-led primary care, we assessed the effect of lockdown on provision of care. In the general pregnant population, the impact on characteristics of labour and maternal morbidity was assessed. A difference-in-regression-discontinuity design was used to derive causal estimates for the year 2020.RESULTS: A total of 1,039,728 births were included. During the lockdown, births to women who started labour in midwife-led primary care (49%) more often ended at home (27% pre-lockdown, +10% [95% confidence interval: +7%, +13%]). A small decrease was seen in referrals towards obstetrician-led care during labour (46%, -3% [-5%,-0%]). In the overall group, no significant change was seen in induction of labour (27%, +1% [-1%, +3%]). We found no significant changes in the incidence of emergency caesarean section (9%, -1% [-2%, +0%]), obstetric anal sphincter injury (2%, +0% [-0%, +1%]), episiotomy (21%, -0% [-2%, +1%]), or post-partum haemorrhage: >1000 ml (6%, -0% [-1%, +1%]).CONCLUSIONS: During the first COVID-19 lockdown in the Netherlands, a substantial increase in homebirths was seen. There was no evidence for changed available maternal outcomes, suggesting that a maternity care system with a strong midwife-led primary care system may flexibly and safely adapt to external disruptions.

AB - OBJECTIVES:The COVID-19 pandemic and associated lockdowns disrupted health care worldwide. High-income countries observed a decrease in preterm births during lockdowns, but maternal pregnancy-related outcomes were also likely affected. This study investigates the effect of the first COVID-19 lockdown (March-June 2020) on provision of maternity care and maternal pregnancy-related outcomes in the Netherlands.STUDY DESIGN: National quasi-experimental study.METHODS: Multiple linked national registries were used, and all births from a gestational age of 24+0 weeks in 2010-2020 were included. In births starting in midwife-led primary care, we assessed the effect of lockdown on provision of care. In the general pregnant population, the impact on characteristics of labour and maternal morbidity was assessed. A difference-in-regression-discontinuity design was used to derive causal estimates for the year 2020.RESULTS: A total of 1,039,728 births were included. During the lockdown, births to women who started labour in midwife-led primary care (49%) more often ended at home (27% pre-lockdown, +10% [95% confidence interval: +7%, +13%]). A small decrease was seen in referrals towards obstetrician-led care during labour (46%, -3% [-5%,-0%]). In the overall group, no significant change was seen in induction of labour (27%, +1% [-1%, +3%]). We found no significant changes in the incidence of emergency caesarean section (9%, -1% [-2%, +0%]), obstetric anal sphincter injury (2%, +0% [-0%, +1%]), episiotomy (21%, -0% [-2%, +1%]), or post-partum haemorrhage: >1000 ml (6%, -0% [-1%, +1%]).CONCLUSIONS: During the first COVID-19 lockdown in the Netherlands, a substantial increase in homebirths was seen. There was no evidence for changed available maternal outcomes, suggesting that a maternity care system with a strong midwife-led primary care system may flexibly and safely adapt to external disruptions.

UR - http://www.scopus.com/inward/record.url?scp=85199061463&partnerID=8YFLogxK

U2 - 10.1016/j.puhe.2024.06.024

DO - 10.1016/j.puhe.2024.06.024

M3 - Article

C2 - 39033718

AN - SCOPUS:85199061463

SN - 0033-3506

VL - 235

SP - 15

EP - 25

JO - Public Health

JF - Public Health

ER -

Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands: a national quasi-experimental study

Abstract

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