title: The Dutch Birth Centre Study: study design of a programmatic evaluation of the effect of birth centre care in the Netherlands.
abstract: BACKGROUND
  Birth centres are regarded as settings where women with uncomplicated pregnancies can give birth, assisted by a midwife and a maternity care assistant. In case of (threatening) complications referral to a maternity unit of a hospital is necessary. In the last decade up to 20 different birth centres have been instituted in the Netherlands. This increase in birth centres is attributed to various reasons such as a safe and easy accessible place of birth, organizational efficiency in integration of care and direct access to obstetric hospital care if needed, and better use of maternity care assistance. Birth centres are assumed to offer increased integration and quality of care and thus to contribute to better perinatal and maternal outcomes. So far there is no evidence for this assumption as no previous studies of birth centres have been carried out in the Netherlands.
  
  
  METHODS
  The aims are 1) Identification of birth centres and measuring integration of organization and care 2) Measuring the quality of birth centre care 3) Effects of introducing a birth centre on regional quality and provision of care 4) Cost-effectiveness analysis 5) In depth longitudinal analysis of the organization and processes in birth centres. Different qualitative and quantitative methods will be used in the different sub studies. The design is a multi-centre, multi-method study, including surveys, interviews, observations, and analysis of registration data and documents.
  
  
  CONCLUSIONS
  The results of this study will enable users of maternity care, professionals, policy makers and health care financers to make an informed choice about the kind of birth location that is appropriate for their needs and wishes.
authors.affiliation: Department of Child Health, TNO, PO Box 2215, 2301 CE, Leiden, The Netherlands. marieke.hermus@tno.nl.|Department of Obstetrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands. marieke.hermus@tno.nl.|Midwifery Practice Trivia, Werkmansbeemd 2, 4907 EW, Oosterhout, The Netherlands. marieke.hermus@tno.nl.
authors.forename: Marieke A A
authors.initials: MA
authors.lastname: Hermus
authors.affiliation: NIVEL (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN, Utrecht, The Netherlands. t.wiegers@nivel.nl.
authors.forename: Therese A
authors.initials: TA
authors.lastname: Wiegers
authors.affiliation: Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. m.hitzert@erasmusmc.nl.
authors.forename: Marit F
authors.initials: MF
authors.lastname: Hitzert
authors.affiliation: Jan van Es Institute, Netherlands Expert Centre Integrated Primary Care, Randstad 2145-a 1314 BG, Almere, The Netherlands. i.boesveld@jvei.nl.
authors.forename: Inge C
authors.initials: IC
authors.lastname: Boesveld
authors.affiliation: Department of Medical decision making, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands. M.E.van_den_Akker-van_Marle@lumc.nl.
authors.forename: M Elske
authors.initials: ME
authors.lastname: van den Akker-van Marle
authors.affiliation: Department of Management, Tilburg School of Economics and Management, PO Box 90153, 5000 LE, Tilburg, The Netherlands. ha@uvt.nl.
authors.forename: Henk A
authors.initials: HA
authors.lastname: Akkermans
authors.affiliation: Jan van Es Institute, Netherlands Expert Centre Integrated Primary Care, Randstad 2145-a 1314 BG, Almere, The Netherlands. m.bruijnzeels@jvei.nl.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Bruijnzeels
authors.affiliation: Division Woman and Baby, University Medical Centre Utrecht, PO box 85500, 3508 GA, Utrecht, The Netherlands. A.Franx-2@umcutrecht.nl.
authors.forename: Arie
authors.initials: A
authors.lastname: Franx
authors.affiliation: Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. j.degraaf@erasmusmc.nl.
authors.forename: Johanna P
authors.initials: JP
authors.lastname: de Graaf
authors.affiliation: Department of Child Health, TNO, PO Box 2215, 2301 CE, Leiden, The Netherlands. marlies.rijnders@tno.nl.
authors.forename: Marlies E B
authors.initials: ME
authors.lastname: Rijnders
authors.affiliation: Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. e.a.p.steegers@erasmusmc.nl.
authors.forename: Eric A P
authors.initials: EA
authors.lastname: Steegers
authors.affiliation: Department of Child Health, TNO, PO Box 2215, 2301 CE, Leiden, The Netherlands. karin.vanderpal@tno.nl.
authors.forename: Karin M
authors.initials: KM
authors.lastname: van der Pal-de Bruin
mesh_terms: D016550:Birthing Centers / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D003266:Continuity of Patient Care; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008427:Maternal Health Services / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D008880:Midwifery / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care; D011247:Pregnancy; D011256:Pregnancy Outcome; D015397:Program Evaluation; D036301:Qualitative Research; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012042:Registries; D011795:Surveys and Questionnaires