title: Intrapartum and neonatal mortality in primary midwife-led and secondary obstetrician-led care in the Amsterdam region of the Netherlands: A retrospective cohort study.
abstract: OBJECTIVE
  To compare intrapartum- and neonatal mortality and intervention rates in term women starting labour in primary midwife-led versus secondary obstetrician-led care.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Amsterdam region of the Netherlands.
  
  
  METHODS
  Women with singleton pregnancies who gave birth beyond 37+0 weeks gestation in the years 2005 up to 2008 and lived in the catchment area of the neonatal intensive care units of both academic hospitals in Amsterdam. Women with a primary caesarean section or a pregnancy complicated by antepartum death or major congenital anomalies were excluded. For women in the midwife-led care group, a home or hospital birth could be planned.
  
  
  METHODS
  Analysis of linked data from the national perinatal register, and hospital- and midwifery record data. We assessed (unadjusted) relative risks with confidence intervals. Main outcome measures were incidences of intrapartum and neonatal (<28 days) mortality. Secondary outcomes included incidences of caesarean section and vaginal instrumental delivery.
  
  
  RESULTS
  53,123 women started labour in primary care and 30,166 women in secondary care. Intrapartum and neonatal mortality rates were 37/53,123 (0.70‰) in the primary care group and 24/30,166 (0.80‰) in the secondary care group (relative risk 0.88; 95% CI 0.52-1.46). Women in the primary care group were less likely to deliver by secondary caesarean section (5% versus 16%; RR 0.31; 95% CI 0.30-0.32) or by instrumental delivery (10% versus 13%; RR 0.76; 95% CI 0.73-0.79).
  
  
  CONCLUSIONS
  We found a low absolute risk of intrapartum and neonatal mortality, with a comparable risk for women who started labour in primary versus secondary care. The intervention rate was significantly lower in women who started labour in primary care.
  
  
  CONCLUSIONS
  These findings suggest that it is possible to identify a group of women at low risk of complications that can start labour in primary care and have low rates of medical interventions whereas perinatal mortality is low.
authors.affiliation: Academic Medical Center, Department of Obstetrics and Gynaecology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: m.m.wiegerinck@amc.uva.nl.
authors.forename: M M J
authors.initials: MM
authors.lastname: Wiegerinck
authors.affiliation: Academic Medical Center, Department of Obstetrics and Gynaecology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: b.y.vandergoes@amc.uva.nl.
authors.forename: B Y
authors.initials: BY
authors.lastname: van der Goes
authors.affiliation: Academic Medical Center, Department of Medical Informatics, 1100 DE Amsterdam, The Netherlands; Academic Medical Center, Department of Obstetrics, PO Box 22700, 1100 DE Amsterdam, The Netherlands. Electronic address: a.c.ravelli@amc.uva.nl.
authors.forename: A C J
authors.initials: AC
authors.lastname: Ravelli
authors.affiliation: Academic Medical Center, Department of Obstetrics and Gynaecology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: j.a.vanderpost@amc.uva.nl.
authors.forename: J A M
authors.initials: JA
authors.lastname: van der Post
authors.affiliation: Midwives in Primary care Amsterdam and Amstelland (EVAA), Rijtuigenhof 105, 1054 NC Amsterdam, The Netherlands. Electronic address: jokeklinkert@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Klinkert
authors.affiliation: Practice for Obstetrics, Dietetics and Coaching, Margaretha van Borsselenlaan 39, 1181 CZ, Amstelveen, The Netherlands. Electronic address: jokebrandenbarg@xs4all.nl.
authors.forename: J
authors.initials: J
authors.lastname: Brandenbarg
authors.affiliation: VU University Medical Center, Department of Obstetrics and Gynaecology, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. Electronic address: fcd.buist@vumc.nl.
authors.forename: F C D
authors.initials: FC
authors.lastname: Buist
authors.affiliation: VU University Medical Center, Department of Obstetrics and Gynaecology, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. Electronic address: mgaj.wouters@vumc.nl.
authors.forename: M G A J
authors.initials: MG
authors.lastname: Wouters
authors.affiliation: Emma Children's Hospital AMC, Neonatal Intensive Care, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: p.tamminga@amc.uva.nl.
authors.forename: P
authors.initials: P
authors.lastname: Tamminga
authors.affiliation: AVAG/ EMGO+, VU University Medical Center, Department of Midwifery Science, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. Electronic address: ank.dejonge@vumc.nl.
authors.forename: A
authors.initials: A
authors.lastname: de Jonge
authors.affiliation: The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, K William Street 72, 5000SA Adelaide, Australia. Electronic address: b.w.mol@amc.uva.nl.
authors.forename: B W
authors.initials: BW
authors.lastname: Mol
mesh_terms: D000328:Adult; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D005313:Fetal Death; D006700:Home Childbirth / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007743:Labor, Obstetric; D008880:Midwifery; D009426:Netherlands / Q000453:epidemiology; D054238:Perinatal Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011295:Prenatal Care; D011320:Primary Health Care; D055815:Young Adult
keywords: Home birth; Intrapartum mortality; Midwifery; Neonatal mortality; Perinatal mortality