[Relationship between socioeconomic status and differences in health care utilization in pregnancy, delivery and puerperium].
OBJECTIVE
Description of differences in pre-, peri- and postnatal care, according to socio-economic status (SES).


METHODS
Geographically defined areas of 21 child health clinics (CHC) in several parts of the Netherlands.


METHODS
Retrospective cohort study.


METHODS
Of all women who delivered a live-born child in the period April 1988-October 1989 and who were residents of the districts of the CHCs (n = 2119), data were recorded during the home visit post partum by the district nurses. Complete data were available of 2060 (97.2%) mothers. The care provided was defined as prenatal care and attendance at delivery (midwife, general practitioner, obstetrician and combinations), place and mode of delivery, and place of lying-in period. The indicator for SES was the educational level of the mother. In multivariate analyses, age, parity, degree of urbanisation of residential area, distance between home and hospital, ethnicity, height, smoking, health problems during pregnancy, obstetrical history, preterm birth and low birth weight were included in order to correct for possible confounding effects of these factors.


RESULTS
Compared to the higher SES group, there was an increased risk in the lower SES group for a delivery in hospital (OR 1.60; 95% CI 1.16-2.20); the probability of having a complete lying-in period at home decreased according to the SES level (low SES: OR 0.47; 95% CI 0.34-0.65). Differences in mode of delivery (notably caesarean section) were very small and not significant.


CONCLUSIONS
In the Netherlands there are socio-economic differences in perinatal care and the place of the lying-in period. Women of higher SES delivered more often at home and more often had their lying-in period at home, irrespective of other factors. Preferences of the mothers with respect to place of confinement were not taken into account in this study.
Nederlands Instituut voor Praeventieve Gezondheidszorg TNO, Leiden.
W P
WP
Herngreen
J D
JD
Reerink
B M
BM
van Noord-Zaadstra
S P
SP
Verloove-Vanhorick
J H
JH
Ruys
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods; D003710:Demography; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D009426:Netherlands; D011181:Postnatal Care / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors
Verband tussen sociaal-economische status en verschillen in gebruik van zorg bij zwangerschap, bevalling en kraamperiode.