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. 2024 Oct:235:15-25.
doi: 10.1016/j.puhe.2024.06.024. Epub 2024 Jul 20.

Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands: a national quasi-experimental study

B Y Gravesteijn  1 , N W Boderie  2 , T van den Akker  3 , L C M Bertens  4 , K Bloemenkamp  5 , L Burgos Ochoa  6 , A de Jonge  7 , B M Kazemier  8 , P P F Klein  9 , I Kwint-Reijnders  10 , J A Labrecque  11 , B W Mol  12 , S A Obermann-Borst  13 , L Peters  14 , A C J Ravelli  15 , A Rosman  16 , J V Been  17 , C J de Groot  18 ; PREPARE-consortium
Collaborators, Affiliations
Free article

Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands: a national quasi-experimental study

B Y Gravesteijn et al. Public Health. 2024 Oct.
Free 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 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.

Keywords: COVID-19; Homebirth; Maternal health; Natural experiment; SARS-CoV−2.

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