Intrapartum and neonatal mortality among low-risk women in midwife-led versus obstetrician-led care in the Amsterdam region of the Netherlands: a propensity score matched study.

Content Provider	Europe PMC
Author	Wiegerinck, Melanie M J van der Goes, Birgit Y Ravelli, Anita C J van der Post, Joris A M Buist, Fayette C D Tamminga, Pieter Mol, Ben W
Copyright Year	2018
Abstract	ObjectiveTo compare intrapartum and neonatal mortality in low-risk term women starting labour in midwife-led versus obstetrician-led care.Study designWe performed a propensity score matched study using data from our national perinatal register, completed with data from medical files. We studied women without major risk factors with singleton pregnancies who gave birth at term between 2005 and 2008 in the Amsterdam region of the Netherlands. Major risk factors comprised non-vertex position of the fetus, previous Caesarean birth, hypertension, (gestational) diabetes mellitus, post-term pregnancy (≥42 weeks), prolonged rupture of membranes (>24 hours), vaginal bleeding in the second half of pregnancy or induced labour. Groups were devided by midwife-led versus obstetrician-led care at the onset of labour. The primary outcome was intrapartum and neonatal (<28 days) mortality. Secondary outcomes included obstetric interventions, 5 min Apgar scores<7 and neonatal intensive care admittance for >24 hours.ResultsWe studied 57 396 women. Perinatal mortality occurred in 30 of 46 764 (0.64‰) women in midwife-led care and in 2 of 10 632 (0.19‰) women in obstetrician-led care (OR 3.4, 95% CI 0.82 to 14.3). A propensity score matched analysis in a 1:1 ratio with 10 632 women per group revealed an OR for perinatal mortality of 4.0 (95% CI 0.85 to 18.9).ConclusionAmong low-risk women, midwife-led care at the onset of labour was associated with a statistically non-significant higher mortality rate.
Journal	BMJ Open
Volume Number	8
PubMed Central reference number	PMC5781008
Issue Number	1
PubMed reference number	29306890
e-ISSN	20446055
DOI	10.1136/bmjopen-2017-018845
Language	English
Publisher	BMJ Publishing Group
Publisher Date	2018-01-05
Publisher Place	London
Access Restriction	Open
Rights License	This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Subject Keyword	midwifery low risk perinatal mortality intrapartum mortality neonatal mortality home birth
Content Type	Text
Resource Type	Article
Subject	Medicine