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

ObjectivesTo 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.DesignProspective cohort study.SettingLow-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.Participants3455 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 measurementsThe 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.ResultsThere 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.ConclusionThe 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.

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Faculty Opinions recommendation of Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13834961.15274062 ◽

2012 ◽

Author(s):

Jane Norman ◽

Sarah Stock

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Low Risk ◽

Maternal Outcomes ◽

Place Of Birth ◽

Healthy Women

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Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study

BMJ ◽

10.1136/bmj.d7400 ◽

2011 ◽

Vol 343 (nov23 4) ◽

pp. d7400-d7400 ◽

Cited By ~ 414

Author(s):

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Low Risk ◽

Maternal Outcomes ◽

Place Of Birth ◽

Healthy Women

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High-risk pregnancies and their association with severe maternal morbidity in Nepal: A prospective cohort study

PLoS ONE ◽

10.1371/journal.pone.0244072 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0244072

Author(s):

Sushma Rajbanshi ◽

Mohd Noor Norhayati ◽

Nik Hussain Nik Hazlina

Keyword(s):

Cohort Study ◽

High Risk ◽

Risk Stratification ◽

Antenatal Care ◽

Pregnant Women ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Maternal Morbidity ◽

Low Risk ◽

Severe Maternal Morbidity

Background The early identification of pregnant women at risk of developing complications at birth is fundamental to antenatal care and an important strategy in preventing maternal death. This study aimed to determine the prevalence of high-risk pregnancies and explore the association between risk stratification and severe maternal morbidity. Methods This hospital-based prospective cohort study included 346 pregnant women between 28–32 gestational weeks who were followed up after childbirth at Koshi Hospital in Nepal. The Malaysian antenatal risk stratification approach, which applies four color codes, was used: red and yellow denote high-risk women, while green and white indicate low-risk women based on maternal past and present medical and obstetric risk factors. The World Health Organization criteria were used to identify women with severe maternal morbidity. Multivariate confirmatory logistic regression analysis was performed to adjust for possible confounders (age and mode of birth) and explore the association between risk stratification and severe maternal morbidity. Results The prevalence of high-risk pregnancies was 14.4%. Based on the color-coded risk stratification, 7.5% of the women were categorized red, 6.9% yellow, 72.0% green, and 13.6% white. The women with high-risk pregnancies were 4.2 times more likely to develop severe maternal morbidity conditions during childbirth. Conclusions Although smaller in percentage, the chances of severe maternal morbidity among high-risk pregnancies were higher than those of low-risk pregnancies. This risk scoring approach shows the potential to predict severe maternal morbidity if routine screening is implemented at antenatal care services. Notwithstanding, unpredictable severe maternal morbidity events also occur among low-risk pregnant women, thus all pregnant women require vigilance and quality obstetrics care but high-risk pregnant women require specialized care and referral.

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