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

B. Y. Gravesteijn; N. Boderie; PREPARE-consortium; T. van den Akker; Loes C.M. Bertens; K. Bloemenkamp; L. Burgos Ochoa; Ank de Jonge; B. M. Kazemier; P. P. Klein; Igna 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

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
, PREPARE-consortium
, T. van den Akker
, Loes C.M. Bertens
, K. Bloemenkamp
, L. Burgos Ochoa
, Ank de Jonge
, B. M. Kazemier
, P. P. Klein
, Igna 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

^*Corresponding author for this work

Amsterdam UMC
Leiden University
Vrije Universiteit Amsterdam
Utrecht University
Tilburg University
Midwifery Academy Amsterdam Groningen
Amsterdam Public Health Research Institute
University Medical Centre Groningen
Rijksinstituut voor Volksgezondheid en Milieu (RIVM)
Sophia Children's Hospital
Care4Neo Foundation
Monash University
Perined
Amsterdam Reproduction and Development Research Institute
Maastricht University
HELLP Stichting
Donders Institute for Brain, Cognition and Behaviour
Radboud University Nijmegen
Hogeschool Zuyd
CAPHRI - Care and Public Health Research Institute
Netherlands Institute for Health Services Research
Radboud University Medical Center
Municipal Health Service of Amsterdam
Environmental Protection Agency
Erasmus University Rotterdam
Erasmus University Medical Centre

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

1 Citation (Scopus)

87 Downloads (Pure)

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

Bibliographical note

UN SDGs

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

SDG 3 Good Health and Well-being

Access to Document

10.1016/j.puhe.2024.06.024Licence: CC BY

1-s2.0-S0033350624002658-mainFinal published version, 1.16 MBLicence: CC BY

Cite this

Gravesteijn, B. Y., Boderie, N., PREPARE-consortium, 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. (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 PREPARE-consortium and \{van den Akker\}, T. and Bertens, \{Loes C.M.\} and K. Bloemenkamp and \{Burgos Ochoa\}, L. and \{de Jonge\}, Ank and Kazemier, \{B. M.\} and Klein, \{P. P.\} and Igna 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 L. Burdorf and \{de Weerth\}, C. and A. Franx and M. Nieuwenhuijze 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, PREPARE-consortium, 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 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 - 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.

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 -

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

Abstract

Bibliographical note

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this