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. 2017 Nov 16;7(11):e016958.
doi: 10.1136/bmjopen-2017-016958.

Differences in optimality index between planned place of birth in a birth centre and alternative planned places of birth, a nationwide prospective cohort study in The Netherlands: results of the Dutch Birth Centre Study

Marieke A A Hermus  1   2   3 , Marit Hitzert  4 , Inge C Boesveld  5 , M Elske van den Akker-van Marle  6 , Paula van Dommelen  7 , Arie Franx  8 , Johanna P de Graaf  4 , Jan M M van Lith  2 , Nathalie Luurssen-Masurel  1 , Eric A P Steegers  4 , Therese A Wiegers  9 , Karin M van der Pal-de Bruin  1
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Differences in optimality index between planned place of birth in a birth centre and alternative planned places of birth, a nationwide prospective cohort study in The Netherlands: results of the Dutch Birth Centre Study

Marieke A A Hermus et al. BMJ Open. .

Abstract

Objectives: To compare the Optimality Index of planned birth in a birth centre with planned birth in a hospital and planned home birth for low-risk term pregnant women who start labour under the responsibility of a community midwife.

Design: Prospective cohort study.

Setting: Low-risk pregnant women under care of a community midwife and living in a region with one of the 21 participating Dutch birth centres or in a region with the possibility for midwife-led hospital birth. Home birth was commonly available in all regions included in the study.

Participants: 3455 low-risk term pregnant women (1686 nulliparous and 1769 multiparous) who gave birth between 1 July 2013 and 31 December 2013: 1668 planned birth centre births, 701 planned midwife-led hospital births and 1086 planned home births.

Main outcome measurements: The Optimality IndexNL-2015, a tool to measure 'maximum outcome with minimal intervention', was assessed by planned place of birth being a birth centre, a hospital setting or at home. Also, a composite maternal and perinatal adverse outcome score was calculated for the different planned places of birth.

Results: There were no differences in Optimality Index NL-2015 for pregnant women who planned to give birth in a birth centre compared with women who planned to give birth in a hospital. Although effect sizes were small, women who planned to give birth at home had a higher Optimality Index NL-2015 than women who planned to give birth in a birth centre. The differences were larger for multiparous than for nulliparous women.

Conclusion: The Optimality Index NL-2015 for women with planned birth centre births was comparable with planned midwife-led hospital births. Women with planned home births had a higher Optimality Index NL-2015, that is, a higher sum score of evidence-based items with an optimal value than women with planned birth centre births.

Keywords: birthing centres; delivery rooms; midwife-led units; midwifery; outcome assessment (health care); the Netherlands.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure format (www.icmje.org/coi_disclosure.pdf) and declare: “all authors had financial support from The Netherlands Organisation for Health Research and Development (ZonMw) for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.”

Figures

Figure 1
Figure 1
Flow diagram of study selection for inclusion. ^D-indications according to the List of Obstetric Indications: due to medium-risk situation birth on obstetric unit . PPROM, premature prelabour rupture of membranes.
See this image and copyright information in PMC

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