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 - PREPARE-consortium
AU - van den Akker, T.
AU - Bertens, Loes C.M.
AU - Bloemenkamp, K.
AU - Burgos Ochoa, L.
AU - de Jonge, Ank
AU - Kazemier, B. M.
AU - Klein, P. P.
AU - Kwint-Reijnders, Igna
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 - Burdorf, L.
AU - de Weerth, C.
AU - Franx, A.
AU - Nieuwenhuijze, 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.
N1 - © 2024 The Author(s). Published by Elsevier Ltd on behalf of The Royal Society for Public Health.
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 - https://www.scopus.com/pages/publications/85199061463
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 -
