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

B. Y. Gravesteijn; N. W. Boderie; T. van den Akker; L. C.M. Bertens; K. Bloemenkamp; L. Burgos Ochoa; A. de Jonge; B. M. Kazemier; P. P.F. Klein; I. Kwint-Reijnders; J. A. Labrecque; B. W. Mol; S. A. Obermann-Borst; L. Peters; A. C.J. Ravelli; A. Rosman; J. V. Been; C. J. de Groot; E. Ambrosino; K. V. Auweele; J. Been; R. Beijers; L. Bertens; N. Boderie; L. Burdorf; L. B. Ochoa; C. de Weerth; A. Franx; S. Harper; P. P. Klein; D. Kretz; J. Labrecque; J. Muris; M. Nieuwenhuijze; S. Obermann; M. Oudijk; L. Ramerman; A. Ravelli; A. Schonewille-Rosman; J. Struijs; H. Torij; M. Van Beukering; M. van den Heuvel; J. van Dillen; F. van Lenthe; T. Van Ourti; A. Verhoeff; M. Vermeulen; N. Visser; S. Willers; S. Schoenmakers; Z. Zainularab

doi:10.1016/j.puhe.2024.06.024

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

B. Y. Gravesteijn, N. W. Boderie, T. van den Akker, L. C.M. Bertens, K. Bloemenkamp, L. Burgos Ochoa, A. de Jonge, B. M. Kazemier, P. P.F. Klein, I. Kwint-Reijnders, J. A. Labrecque, B. W. Mol, S. A. Obermann-Borst, L. Peters, A. C.J. Ravelli, A. Rosman, J. V. Been, C. J. de Groot, E. Ambrosino, K. V. AuweeleJ. Been, R. Beijers, L. Bertens, N. Boderie, L. Burdorf, L. B. Ochoa, C. de Weerth, A. Franx, S. Harper, P. P. Klein, D. Kretz, J. Labrecque, J. Muris, M. Nieuwenhuijze, S. Obermann, M. Oudijk, L. Ramerman, A. Ravelli, A. Schonewille-Rosman, J. Struijs, H. Torij, M. Van Beukering, M. van den Heuvel, J. van Dillen, F. van Lenthe, T. Van Ourti, A. Verhoeff, M. Vermeulen, N. Visser, S. Willers, S. Schoenmakers, Z. Zainularab

Research output: Contribution to journal › Article › peer-review

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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%, âˆ’3% [âˆ’5%,âˆ’0%]). In the overall group, no significant change was seen in induction of labour (27%, +1% [âˆ’1%, +3%]). We found no significant changes in the incidence of emergency caesarean section (9%, âˆ’1% [âˆ’2%, +0%]), obstetric anal sphincter injury (2%, +0% [âˆ’0%, +1%]), episiotomy (21%, âˆ’0% [âˆ’2%, +1%]), or post-partum haemorrhage: >1000 ml (6%, âˆ’0% [âˆ’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.

Original language	English
Pages (from-to)	15-25
Number of pages	11
Journal	Public Health
Volume	235
DOIs	https://doi.org/10.1016/j.puhe.2024.06.024
Publication status	Published - Oct 2024
Externally published	Yes

Bibliographical note

Publisher Copyright:
© 2024 The Author(s)

Keywords

COVID-19
Homebirth
Maternal health
Natural experiment
SARS-CoV−2

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.puhe.2024.06.024

Cite this

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. F., Kwint-Reijnders, I., Labrecque, J. A., Mol, B. W., Obermann-Borst, S. A., Peters, L., Ravelli, A. C. J., Rosman, A., Been, J. V., de Groot, C. J., Ambrosino, E., ... Zainularab, Z. (2024). Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands: a national quasi-experimental study. Public Health, 235, 15-25. https://doi.org/10.1016/j.puhe.2024.06.024

@article{36074f3be01d4f76a2ed56a630a5980e,

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

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%, {\^a}ˆ{\textquoteright}3% [{\^a}ˆ{\textquoteright}5%,{\^a}ˆ{\textquoteright}0%]). In the overall group, no significant change was seen in induction of labour (27%, +1% [{\^a}ˆ{\textquoteright}1%, +3%]). We found no significant changes in the incidence of emergency caesarean section (9%, {\^a}ˆ{\textquoteright}1% [{\^a}ˆ{\textquoteright}2%, +0%]), obstetric anal sphincter injury (2%, +0% [{\^a}ˆ{\textquoteright}0%, +1%]), episiotomy (21%, {\^a}ˆ{\textquoteright}0% [{\^a}ˆ{\textquoteright}2%, +1%]), or post-partum haemorrhage: >1000 ml (6%, {\^a}ˆ{\textquoteright}0% [{\^a}ˆ{\textquoteright}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",

author = "Gravesteijn, {B. Y.} and Boderie, {N. W.} and {van den Akker}, T. and Bertens, {L. C.M.} and K. Bloemenkamp and {Burgos Ochoa}, L. and {de Jonge}, A. and Kazemier, {B. M.} and Klein, {P. P.F.} and I. Kwint-Reijnders and Labrecque, {J. A.} and Mol, {B. W.} and Obermann-Borst, {S. A.} and L. Peters and Ravelli, {A. C.J.} and A. Rosman and Been, {J. V.} and {de Groot}, {C. J.} and E. Ambrosino and Auweele, {K. V.} and J. Been and R. Beijers and L. Bertens and N. Boderie and L. Burdorf and Ochoa, {L. B.} and {de Weerth}, C. and A. Franx and S. Harper and Klein, {P. P.} and D. Kretz and J. Labrecque and J. Muris and M. Nieuwenhuijze and S. Obermann and M. Oudijk and L. Ramerman and A. Ravelli and A. Schonewille-Rosman and J. Struijs and H. Torij and {Van Beukering}, M. and {van den Heuvel}, M. and {van Dillen}, J. and {van Lenthe}, F. and {Van Ourti}, T. and A. Verhoeff and M. Vermeulen and N. Visser and S. Willers and S. Schoenmakers and Z. Zainularab",

note = "Publisher Copyright: {\textcopyright} 2024 The Author(s)",

year = "2024",

month = oct,

doi = "10.1016/j.puhe.2024.06.024",

language = "English",

volume = "235",

pages = "15--25",

journal = "Public Health",

issn = "0033-3506",

publisher = "Elsevier B.V.",

}

Gravesteijn, BY, Boderie, NW, van den Akker, T, Bertens, LCM, Bloemenkamp, K, Burgos Ochoa, L, de Jonge, A, Kazemier, BM, Klein, PPF, Kwint-Reijnders, I, Labrecque, JA, Mol, BW, Obermann-Borst, SA, Peters, L, Ravelli, ACJ, Rosman, A, Been, JV, de Groot, CJ, Ambrosino, E, Auweele, KV, Been, J, Beijers, R, Bertens, L, Boderie, N, Burdorf, L, Ochoa, LB, de Weerth, C, Franx, A, Harper, S, Klein, PP, 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, 'Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands: a national quasi-experimental study', Public Health, vol. 235, pp. 15-25. https://doi.org/10.1016/j.puhe.2024.06.024

TY - JOUR

T1 - Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands

T2 - a national quasi-experimental study

AU - Gravesteijn, B. Y.

AU - Boderie, N. W.

AU - van den Akker, T.

AU - Bertens, L. C.M.

AU - Bloemenkamp, K.

AU - Burgos Ochoa, L.

AU - de Jonge, A.

AU - Kazemier, B. M.

AU - Klein, P. P.F.

AU - Kwint-Reijnders, I.

AU - Labrecque, J. A.

AU - Mol, B. W.

AU - Obermann-Borst, S. A.

AU - Peters, L.

AU - Ravelli, A. C.J.

AU - Rosman, A.

AU - Been, J. V.

AU - de Groot, C. J.

AU - Ambrosino, E.

AU - Auweele, K. V.

AU - Been, J.

AU - Beijers, R.

AU - Bertens, L.

AU - Boderie, N.

AU - Burdorf, L.

AU - Ochoa, L. B.

AU - de Weerth, C.

AU - Franx, A.

AU - Harper, S.

AU - Klein, P. P.

AU - Kretz, D.

AU - Labrecque, J.

AU - Muris, J.

AU - Nieuwenhuijze, M.

AU - Obermann, S.

AU - Oudijk, M.

AU - Ramerman, L.

AU - Ravelli, A.

AU - Schonewille-Rosman, A.

AU - Struijs, J.

AU - Torij, H.

AU - Van Beukering, M.

AU - van den Heuvel, M.

AU - van Dillen, J.

AU - van Lenthe, F.

AU - Van Ourti, T.

AU - Verhoeff, A.

AU - Vermeulen, M.

AU - Visser, N.

AU - Willers, S.

AU - Schoenmakers, S.

AU - Zainularab, Z.

PY - 2024/10

Y1 - 2024/10

N2 - 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%, âˆ’3% [âˆ’5%,âˆ’0%]). In the overall group, no significant change was seen in induction of labour (27%, +1% [âˆ’1%, +3%]). We found no significant changes in the incidence of emergency caesarean section (9%, âˆ’1% [âˆ’2%, +0%]), obstetric anal sphincter injury (2%, +0% [âˆ’0%, +1%]), episiotomy (21%, âˆ’0% [âˆ’2%, +1%]), or post-partum haemorrhage: >1000 ml (6%, âˆ’0% [âˆ’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.

AB - 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%, âˆ’3% [âˆ’5%,âˆ’0%]). In the overall group, no significant change was seen in induction of labour (27%, +1% [âˆ’1%, +3%]). We found no significant changes in the incidence of emergency caesarean section (9%, âˆ’1% [âˆ’2%, +0%]), obstetric anal sphincter injury (2%, +0% [âˆ’0%, +1%]), episiotomy (21%, âˆ’0% [âˆ’2%, +1%]), or post-partum haemorrhage: >1000 ml (6%, âˆ’0% [âˆ’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.

KW - COVID-19

KW - Homebirth

KW - Maternal health

KW - Natural experiment

KW - SARS-CoV−2

UR - http://www.scopus.com/inward/record.url?scp=85199061463&partnerID=8YFLogxK

U2 - 10.1016/j.puhe.2024.06.024

DO - 10.1016/j.puhe.2024.06.024

M3 - Article

C2 - 39033718

AN - SCOPUS:85199061463

SN - 0033-3506

VL - 235

SP - 15

EP - 25

JO - Public Health

JF - Public Health

ER -

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

Abstract

Bibliographical note

Keywords

UN SDGs

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