ArticlePloS one2020
Regional variations in childbirth interventions and their correlations with adverse outcomes, birthplace and care provider: A nationwide explorative study.
Article in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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Who cites it
18 citing papers in PubMed, 30 citations in OpenAlex.
- Midwifery Students' Definitions of Normal Labor and Birth: A Study From Five Countries.Birth (Berkeley, Calif.) · 2026Article
- Risk factors for obstetric anal sphincter injury: an exploratory Norwegian regional cohort study including amniotomy as a potential novel determinant.BMC pregnancy and childbirth · 2025Article
- A five-country comparison of midwifery students' confidence in facilitating normal labor and birth.European journal of midwifery · 2025Article
- Validation of the Greek version of Mothers on Respect (MOR) index.European journal of midwifery · 2025Article
- A Systematic Review of the Use of Routine Versus Selective Episiotomy for Vaginal Birth.Cureus · 2024Review
- Association of personal and systemic factors on intrapartum risk perception and obstetric intervention rates: a cross-sectional study.BMC pregnancy and childbirth · 2024Article
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- The ethics of consent during labour and birth: episiotomies.Journal of medical ethics · 2023Article
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- Experiences, Beliefs, and Values Influencing Midwives' Attitudes Toward the Use of Childbirth Interventions.Journal of midwifery & women's health · 2022Article
- Prevalence of amniotomy in Sweden: a nationwide register study.BMC pregnancy and childbirth · 2022Article
- Modifiable and non-modifiable risk factors for obstetric anal sphincter injury in a Norwegian Region: a case-control study.BMC pregnancy and childbirth · 2022Article
- Article
- Knowledge and skills used for clinical decision-making on childbirth interventions: A qualitative study among midwives in the Netherlands.European journal of midwifery · 2022Article
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- Risk Perception of Health Professionals in Intrapartum Care Decisions: Protocol for a Mixed Methods Study.JMIR research protocols · 2020Article
- Variations in use of childbirth interventions in 13 high-income countries: A multinational cross-sectional study.PLoS medicine · 2020Article
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Authors and funding
8 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundVariations in childbirth interventions may indicate inappropriate use. Most variation studies are limited by the lack of adjustments for maternal characteristics and do not investigate variations in adverse outcomes. This study aims to explore regional variations in the Netherlands and their correlations with referral rates, birthplace, interventions, and adverse outcomes, adjusted for maternal characteristics.
methodsIn this nationwide retrospective cohort study, using a national data register, intervention rates were analysed between twelve regions among single childbirths after 37 weeks' gestation in 2010-2013 (n = 614,730). These were adjusted for maternal characteristics using multivariable logistic regression. Primary outcomes were intrapartum referral, birthplace, and interventions used in midwife- and obstetrician-led care. Correlations both between primary outcomes and between adverse outcomes were calculated with Spearman's rank correlations.
findingsIntrapartum referral rates varied between 55-68% (nulliparous) and 20-32% (multiparous women), with a negative correlation with receiving midwife-led care at the onset of labour in two-thirds of the regions. Regions with higher referral rates had higher rates of severe postpartum haemorrhages. Rates of home birth varied between 6-16% (nulliparous) and 16-31% (multiparous), and was negatively correlated with episiotomy and postpartum oxytocin rates. Among midwife-led births, episiotomy rates varied between 14-42% (nulliparous) and 3-13% (multiparous) and in obstetrician-led births from 46-67% and 14-28% respectively. Rates of postpartum oxytocin varied between 59-88% (nulliparous) and 50-85% (multiparous) and artificial rupture of membranes between 43-52% and 54-61% respectively. A north-south gradient was visible with regard to birthplace, episiotomy, and oxytocin.
conclusionsOur study suggests that attitudes towards interventions vary, independent of maternal characteristics. Care providers and policy makers need to be aware of reducing unwarranted variation in birthplace, episiotomy and the postpartum use of oxytocin. Further research is needed to identify explanations and explore ways to reduce unwarranted intervention rates.
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