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Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands: A national quasi-experimental study
Gravesteijn,B. Boderie,N.W. van den Akker,T. Bertens,L.C.M. Bloemenkamp,K. Ochoa,L. Burgos Jonge,Ank De Kazemier,B.M. Klein,P.P. Kwint-Reijnders,I.
Gravesteijn,B.
Boderie,N.W.
van den Akker,T.
Bertens,L.C.M.
Bloemenkamp,K.
Ochoa,L. Burgos
Jonge,Ank De
Kazemier,B.M.
Klein,P.P.
Kwint-Reijnders,I.
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.
Description
Date
2024-10
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Publisher
Research Projects
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Keywords
COVID-19, Homebirth, Maternal health, Natural experiment, SARS-CoV−2, SDG 3 - Good Health and Well-being
Citation
Gravesteijn, B, Boderie, N W, van den Akker, T, Bertens, L C M, Bloemenkamp, K, Ochoa, L B, Jonge, A D, Kazemier, B M, Klein, P P, Kwint-Reijnders, I, Labrecque, J A, Mol, B W, Obermann-Borst, S, Peters, L L, Ravelli, A, Rosman, A, Been, J, de Groot, C, Ambrosino, E, Auweele, K V, Been, J, Beijers, R, Bertens, L, Bloemenkamp, K, Boderie, N, Burdorf, L, Ochoa, L B, de Jonge, A, de Weerth, C, Franx, A, Harper, S, Kazemier, B M, Klein, P P, Kretz, D, Labrecque, J, Mol, B W, Muris, J, Nieuwenhuijze, M, Obermann, S, Oudijk, M, Peters, L, Ramerman, L, Ravelli, A, Schonewille-Rosman, A, Struijs, J, Torij, H, Beukering, M V, van den Akker, T, van den Heuvel, M, van Dillen, J, van Lenthe, F & Verheij, R 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