title: Effect of planned place of birth on obstetric interventions and maternal outcomes among low-risk women: a cohort study in the Netherlands.
abstract: The use of interventions in childbirth has increased the past decades. There is concern that some women might receive more interventions than they really need. For low-risk women, midwife-led birth settings may be of importance as a counterbalance towards the increasing rate of interventions. The effect of planned place of birth on interventions in the Netherlands is not yet clear. This study aims to give insight into differences in obstetric interventions and maternal outcomes for planned home versus planned hospital birth among women in midwife-led care.
  
  
  
  Women from twenty practices across the Netherlands were included in 2009 and 2010. Of these, 3495 were low-risk and in midwife-led care at the onset of labour. Information about planned place of birth and outcomes, including instrumental birth (caesarean section, vacuum or forceps birth), labour augmentation, episiotomy, oxytocin in third stage, postpartum haemorrhage >1000 ml and perineal damage, came from the national midwife-led care perinatal database, and a postpartum questionnaire.
  
  
  
  Women who planned home birth more often had spontaneous birth (nulliparous women aOR 1.38, 95 % CI 1.08-1.76, parous women aOR 2.29, 95 % CI 1.21-4.36) and less often episiotomy (nulliparous women aOR 0.73, 0.58-0.91, parous women aOR 0.47, 0.33-0.68) and use of oxytocin in the third stage (nulliparous women aOR 0.58, 0.42-0.80, parous women aOR 0.47, 0.37-0.60) compared to women who planned hospital birth. Nulliparous women more often had anal sphincter damage (aOR 1.75, 1.01-3.03), but the difference was not statistically significant if women who had caesarean sections were excluded. Parous women less often had labour augmentation (aOR 0.55, 0.36-0.82) and more often an intact perineum (aOR 1.65, 1.34-2.03). There were no differences in rates of vacuum/forceps birth, unplanned caesarean section and postpartum haemorrhage >1000 ml.
  
  
  
  Women who planned home birth were more likely to give birth spontaneously and had fewer medical interventions.
authors: Department of Midwifery Science, AVAG and the EMGO Institute of Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands. nienkebolten@hotmail.com.
authors: N
authors: 0000-0002-0898-4783
authors: N
authors: Bolten
authors: Department of Midwifery Science, AVAG and the EMGO Institute of Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
authors: A
authors: A
authors: de Jonge
authors: Midwife Academy Amsterdam, AVAG, Amsterdam, The Netherlands.
authors: E
authors: E
authors: Zwagerman
authors: Midwife Academy Amsterdam, AVAG, Amsterdam, The Netherlands.
authors: P
authors: P
authors: Zwagerman
authors: Department of Midwifery Science, AVAG and the EMGO Institute of Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
authors: T
authors: T
authors: Klomp
authors: Department of Obstetrics and Gynaecology, Deventer Hospital, Deventer, The Netherlands.
authors: J J
authors: JJ
authors: Zwart
authors: Department of Midwifery Science, AVAG and the EMGO Institute of Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
authors: C C
authors: CC
authors: Geerts
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data*; D004841:Episiotomy / Q000706:statistics & numerical data; D005260:Female; D006700:Home Childbirth / Q000706:statistics & numerical data*; D006801:Humans; D007749:Labor Stage, Third; D000069342:Medical Overuse; D008880:Midwifery / Q000706:statistics & numerical data*; D009426:Netherlands / Q000453:epidemiology; D010120:Oxytocics / Q000627:therapeutic use; D010121:Oxytocin / Q000627:therapeutic use; D010298:Parity; D018743:Perinatal Care / Q000379:methods / Q000706:statistics & numerical data*; D010502:Perineum / Q000293:injuries; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D012306:Risk; D055815:Young Adult
chemical_list: D010120:Oxytocics; D010121:Oxytocin
keywords: Caesarean section; Home childbirth; Instrumental birth; Midwifery; Obstetrical; Perineal damage; Postpartum haemorrhage