Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands: a national quasi-experimental study
Publication date
2024-10
Authors
Gravesteijn, B. Y.
Boderie, N. W.
van den Akker, T.
Bertens, L. C.M.
Bloemenkamp, Kitty W M
Burgos Ochoa, L.
de Jonge, A.
Kazemier, Brenda M.
Klein, P. P.
Kwint-Reijnders, I.
Editors
Advisors
Supervisors
Document Type
Article
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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%, −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, Public Health, Environmental and Occupational Health
Citation
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, Kwint-Reijnders, I, Labrecque, J, Mol, B W, Obermann, S, Peters, L, Ravelli, A C J, Rosman, A, Been, J, de Groot, C J, Ambrosino, E, Auweele, K V, Been, J, Beijers, R, Bertens, L C M, Boderie, N, Burdorf, L, Ochoa, L B, de Weerth, C, Franx, A, Harper, S, Klein, P P, 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