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

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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 languageEnglish
Pages (from-to)15-25
Number of pages11
JournalPublic Health
Volume235
Early online date20 Jul 2024
DOIs
Publication statusPublished - Oct 2024

Bibliographical note

© 2024 The Author(s). Published by Elsevier Ltd on behalf of The Royal Society for Public Health.

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