TY - JOUR
T1 - Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands
T2 - a national quasi-experimental study
AU - PREPARE consortium
AU - Gravesteijn, B Y
AU - Boderie, N W
AU - van den Akker, T
AU - Bertens, L C M
AU - Bloemenkamp, K
AU - Burgos Ochoa, L
AU - de Jonge, A
AU - Kazemier, B M
AU - Klein, P P F
AU - Kwint-Reijnders, I
AU - Labrecque, J A
AU - Mol, B W
AU - Obermann-Borst, S A
AU - Peters, L
AU - Ravelli, A C J
AU - Rosman, A
AU - Been, J V
AU - de Groot, C J
N1 - Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.
PY - 2024/10
Y1 - 2024/10
N2 - 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.
AB - 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.
KW - Humans
KW - COVID-19/epidemiology
KW - Netherlands/epidemiology
KW - Pregnancy
KW - Female
KW - Maternal Health Services/statistics & numerical data
KW - Adult
KW - Pregnancy Outcome/epidemiology
KW - Midwifery/statistics & numerical data
KW - Communicable Disease Control/methods
KW - SARS-CoV-2
KW - COVID-19
KW - Homebirth
KW - Maternal health
KW - Natural experiment
KW - SARS-CoV−2
UR - http://www.scopus.com/inward/record.url?scp=85199061463&partnerID=8YFLogxK
U2 - 10.1016/j.puhe.2024.06.024
DO - 10.1016/j.puhe.2024.06.024
M3 - Article
C2 - 39033718
SN - 0033-3506
VL - 235
SP - 15
EP - 25
JO - Public health
JF - Public health
ER -
