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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2020

01-12-2020 | Care | Research article

Perinatal outcomes of frequent attendance in midwifery care in the Netherlands: a retrospective cohort study

Authors: Janneke T. Gitsels-van der Wal, Lisanne A. Gitsels, Angelo Hooker, Paula Scholing, Linda Martin, Esther I. Feijen-de Jong

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

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Abstract

Background

Over the last decade, a trend towards high utilisation of primary maternity care was observed in high-income countries. There is limited research with contradictory results regarding frequent attendance (FA) and perinatal outcomes in midwifery care. Therefore, this study examined possible associations between FA in midwifery care and obstetric interventions and perinatal outcomes.

Methods

A retrospective cohort study was performed in a medium-sized midwifery-led care practice in an urban region in the Netherlands. Frequent attenders (FAs) were categorised using the Kotelchuck-Index Revised. Regression analyses were executed to examine the relationship between FAs and perinatal outcomes, stratified by antenatal referral to an obstetrician. Main outcomes of interest were Apgar score ≤ 7 and perinatal death, birth weight, mode of delivery, haemorrhage, place of birth, transfer during labour, and a requirement for pain relief.

Results

The study included 1015 women, 239 (24%) FAs and 776 (76%) non-FAs, 538 (53%) were not referred and 447 (47%) were referred to an obstetrician. In the non-referred group, FA was significantly associated with a requirement for pain relief (OR 1.98, 95% CI 1.24–3.17) and duration of dilatation (OR 1.20, 95% CI 1.04–1.38). In the referred group, FA was significantly associated with induction of labour (OR 1.86, 95% CI 1.17–2.95), ruptured perineum (OR 0.50, 95% CI 0.27–0.95) and episiotomy (OR 0.48, 95% CI 0.24–0.95). In the non-referred and the referred group, FA was not associated with the other obstetric and neonatal outcomes. Due to small numbers, we could not measure possible associations of FA with an Apgar score ≤ 7 and perinatal death.

Conclusion

In our study, perinatal outcomes differed by FA and antenatal referral to an obstetrician. In the non-referred group, FA was significantly associated with medical pain relief and duration of dilatation. In the referred group, FA was significantly associated with induction of labour, ruptured perineum, and episiotomy. Further research with a larger study population is needed to look for a possible association between FA and primary adverse birth outcomes such as perinatal mortality.
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Metadata
Title
Perinatal outcomes of frequent attendance in midwifery care in the Netherlands: a retrospective cohort study
Authors
Janneke T. Gitsels-van der Wal
Lisanne A. Gitsels
Angelo Hooker
Paula Scholing
Linda Martin
Esther I. Feijen-de Jong
Publication date
01-12-2020
Publisher
BioMed Central
Keywords
Care
Episiotomy
Published in
BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-020-02957-1

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