Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands: a national quasi-experimental study
Gravesteijn, B. Y.; Boderie, N. W.; van den Akker, T.; Bertens, L. C.M.; Bloemenkamp, K.; Burgos Ochoa, L.; de Jonge, A.; Kazemier, B. M.; Klein, P. P.; Kwint-Reijnders, I.; Labrecque, J.; Mol, B. W.; Obermann, S.; Peters, L.; Ravelli, A. C.J.; Rosman, A.; Been, J.; de Groot, C. J.; Ambrosino, E.; Auweele, K. V.; Been, J.; Beijers, R.; Bertens, L. C.M.; Boderie, N.; Burdorf, L.; Ochoa, L. B.; de Weerth, C.; Franx, A.; Harper, S.; Klein, P. P.; Kretz, D.; Labrecque, J.; Muris, J.; Nieuwenhuijze, M.; Obermann, S.; Oudijk, M.; Ramerman, L.; Ravelli, A.; Schonewille-Rosman, A.; Struijs, J.; Torij, H.; Van Beukering, M.; van den Heuvel, M.; van Dillen, J.; van Lenthe, F.; Van Ourti, T.; Verhoeff, A.; Vermeulen, M.; Visser, N.; Willers, S.; Schoenmakers, S.; Zainularab, Z.
(2024) Public Health, volume 235, pp. 15 - 25
(Article)
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
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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.
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Keywords: COVID-19, Homebirth, Maternal health, Natural experiment, SARS-CoV−2, Public Health, Environmental and Occupational Health
ISSN: 0033-3506
Publisher: Elsevier
Note: Publisher Copyright: © 2024 The Author(s)
(Peer reviewed)
