Background
Methods
Study design
Participants
Dutch maternity care context
Data collection and perinatal outcomes
Analyses
Results
Complete study population N = 1015 | Frequent attender N = 239 (23.5%) | Non-frequent attender N = 776 (76.5%) | P value | |
---|---|---|---|---|
Consultations | ||||
Face-to-face Mean (sd) | 11 (4.2) | 14 (4.1) | 10 (3.7) | <.01 |
Age in years mean (sd) | 29.3 (4.9) | 28.8 (5.1) | 29.4 (4.8) | .24 |
Level of Education* | .77 | |||
Low | 119 (12.1) | 26 (11.3) | 93 (12.4) | |
Medium | 459 (46.7) | 112 (48.7) | 347 (46.1) | |
High | 405 (41.2) | 92 (40) | 313 (41.6) | |
Ethnic Background* | .08 | |||
Dutch | 483 (47.6) | 128 (53.6) | 355 (45.8) | |
Western Non-Dutch | 82 (8.1) | 14 (5.9) | 68 (8.8) | |
Non-Western Non-Dutch | 449 (44.3) | 97 (40.6) | 352 (45.4) | |
Married/partner | 990 (97.5) | 230 (96.2) | 760 (97.9) | .14 |
Employed* | 696 (69.1) | 165 (69.3) | 531 (69.1) | |
Deprived area | 210 (20.7) | 42 (17.6) | 168 (21.6) | .17 |
Parity | .24 | |||
Nulliparous | 480 (47.3) | 121 (50.6) | 359 (46.3) | |
Multiparous | 535 (52.7) | 118 (49.4) | 417 (53.7 | |
Start of conception* | .03 | |||
Spontaneous | 953 (94.7) | 218 (92) | 735 (95.6) | |
Assisted | 53 (5.3) | 19 (8) | 34 (4.4) | |
Psychosocial problems* | <.01 | |||
Yes in the past | 202 (20) | 58 (24.3)) | 144 (18.6) | |
Yes at present | 87 (8.6) | 35 (14.6) | 52 (6.7) | |
Sexual violence* | 127 (12.5) | 49 (20.6) | 78 (10.1) | <.01 |
Smoking* | 235 (23.2) | 76 (31.8) | 159 (20.5) | <.01 |
Alcohol use* | 42 (4.1) | 18 (7.5) | 24 (3.1) | <.01 |
Drugs addiction* | 22 (2.2) | 9 (3.8) | 13 (1.7) | .05 |
BMI* | .17 | |||
Overweight | 248 (24.5) | 69 (28.9) | 179 (23.2) | |
Obese | 133 (13.2) | 27 (11.3) | 106 (13.7) |
Non-referred frequent attender N = 107 (10.5%) | Non-referred non-frequent attender N = 431 (42.5%) | Referred frequent attender N = 132 (13.0%) | Referred non-frequent attender N = 345 (34.0%) | |||
---|---|---|---|---|---|---|
Consultations | <.01 | <.01 | ||||
Face-to-face Mean (sd) | 15.8 (3.3) | 12.0 (2.5) | 12.6 (4.1) | 7.7 (3.6) | ||
Age in years | .26 | .12 | ||||
mean (sd) | 28.2 (5.0) | 28.8 (4.7) | 29.4 (5.1) | 30.2 (4.9) | ||
Level of Education* | .56 | .81 | ||||
Low | 8 (7.7) | 48 (11.5) | 18 (14.3) | 45 (13.4) | ||
Medium | 54 (51.9) | 194 (46.4) | 58 (46.0) | 153 (45.7) | ||
High | 42 (40.4) | 176 (42.1) | 50 (39.7) | 137 (40.9) | ||
Ethnic Background* | .69 | .03 | ||||
Dutch | 54 (50.5) | 209 (48.5) | 74 (56.1) | 146 (42.4) | ||
Western Non-Dutch | 9 (8.4) | 48 (11.1) | 5 (3.8) | 20 (5.8) | ||
Non-Western Non-Dutch | 44 (41.1) | 174 (40.4) | 53 (40.2) | 178 (51.7) | ||
Married/partner | 103 (96.3) | 419 (97.2) | .62 | 127 (96.2) | 341 (98.8) | .06 |
Employed* | 74 (69.8) | 294 (68.7) | .80 | 91 (68.9) | 237 (69.5) | .90 |
Deprived area | 19 (17.8) | 76 (17.6) | .98 | 23 (17.4) | 92 (26.7) | .04 |
Parity | .46 | .29 | ||||
Nulliparous | 56 (52.3) | 206 (47.8) | 65 (49.2) | 153 (44.3) | ||
Multiparous | 51 (47.7) | 225 (52.2) | 67 (50.8) | 192 (55.7) | ||
Start of conception* | .99 | .16 | ||||
Spontaneous | 102 (96.2) | 410 (96.2) | 116 (88.5) | 325 (94.8) | ||
Assisted | 4 (3.8) | 16 (3.8) | 15 (11.5) | 18 (5.2) | ||
Psychosocial problems* | .51 | <.01 | ||||
Yes in the past | 25 (23.4) | 80 (18.7) | 33 (25.0) | 64 (18.6) | ||
Yes at present | 8 (7.5) | 27 (6.3) | 27 (20.5) | 25 (7.2) | ||
Sexual violence* | 17 (16.0) | 37 (8.6) | .03 | 32 (24.2) | 41 (11.9) | <.01 |
Smoking* | 32 (29.9) | 82 (19.1) | .01 | 44 (33.3) | 77 (22.4) | .02 |
Alcohol use* | 8 (7.5) | 14 (3.3) | .05 | 10 (7.6) | 10 (2.9) | .02 |
Drugs addiction* | 1 (0.9) | 8 (1.9) | .51 | 8 (6.1) | 5 (1.5) | .01 |
BMI* | .67 | .21 | ||||
Overweight | 23 (21.5) | 91 (21.3) | 46 (34.8) | 88 (25.6) | ||
Obese | 5 (4.7) | 39 (9.1) | 22 (16.7) | 67 (19.5) |
Reasons | N (%) |
---|---|
Glucose intolerance | 132 (27.7) |
Pregnancy-induced hypertension | 70 (14.7) |
Previous C-section | 47 (9.9) |
Post terme (≥42 weeks)/request for induction | 30 (6.3) |
Breech or other malpresentation | 27 (5.7) |
Decreased fetal movements | 22 (4.6) |
Intercurrent disease | 17 (3.6) |
Small for gestational age | 16 (3.4) |
Premature birth | 15 (3.1) |
Congenital anomaly | 10 (2.1) |
Large for gestational age | 11 (2.3) |
Anaemia | 11 (2.3) |
Previous small for gestational age | 9 (1.9) |
Hydramnion | 6 (1.3) |
Placenta problems | 5 (1) |
Uterus anomaly/cyst/myomas | 5 (1) |
Stillbirth | 4 (.8) |
Hyperemesis | 2 (.4) |
Fetal distress | 2 (.4) |
Blood loss | 2 (.4) |
Twin pregnancy | 1 (.2) |
Other#, such as cholestasis, maternal heart defects, rheumatism, gastric bypass, pelvic pain | 33 (6.9) |
FAs versus non-FAs
Complete study population N = 1015 (100%) | Frequent attender N = 219 (23.5%) | Non-frequent attender N = 776 (76.5%) | P value | |
---|---|---|---|---|
Apgar Score after 5 min* | .93 | |||
< 8 | 29 (2.9) | 7 (3) | 22 (2.8) | |
Perinatal death | 11 (1.1) | 1 (.4) | 10 (1.3) | .26 |
Birthweight (in percentiles)* | .24 | |||
P < 10 | 101 (10.1) | 19 (8.1) | 82 (10.7) | |
Mode of delivery * | .24 | |||
Spontaneous | 764 (75.5) | 174 (73.1) | 590 (76.2) | |
Vaginal assisted birth | 103 (10.2) | 22 (9.2) | 81 (10.5) | |
Caesarean section | 145 (14.3) | 42 (17.6) | 103 (13.3) | |
Perineum* | .28 | |||
Not ruptured | 442 (50.7) | 109 (54.8) | 333 (49.5) | |
Ruptured | 248 (28.4) | 48 (24.1) | 200 (29.7) | |
Episiotomy | 182 (20.9) | 42 (21.1) | 140 (20.8) | |
Haemorrhage* | 69 (6.9) | 12 (5.1) | 57 (7.5) | .21 |
Place of birth | .01 | |||
Home | 58 (5.7) | 6 (2.5) | 52 (6.7) | |
Birth centre | 215 (22.2) | 41 (17.2) | 163 (21) | |
Hospital | 742 (73.1) | 192 (80.3) | 561 (72.3) | |
Transfer during labour* | 275 (28.6) | 60 (26.4) | 215 (29.3) | .41 |
Induction of labour* | 313 (30.9) | 100 (42) | 213 (27.4) | .00 |
Medical pain relief* | 415 (41) | 124 (52.1) | 291 (37.6) | .00 |
Gestational age at onset of labour in weeks mean (sd) | 39 (2.4) | 38.7 (2.3) | 39 (2.5) | .22 |
Duration of dilatation in hours median (IQR) | 6.0 (.8) | 6.0 (.9) | 6.0 (.8) | .09 |
Duration of expulsion in minutes median (IQR) | 16.0 (1.6) | 14.9 (1.7) | 16.0 (1.6) | .81 |
Non-referred pregnant women
Non-referred frequent attender N = 107 (10.5%) | Non-referred non-frequent attender N = 431 (42.5%) | P value | Referred frequent attender N = 132 (13.0%) | Referred non-frequent attender N = 345 (34.0%) | P value | |
---|---|---|---|---|---|---|
Apgar Score after 5 min* | .19 | .27 | ||||
< 8 | 5 (4.7) | 10 (2.3) | 2 (1.5) | 12 (3.5) | ||
Perinatal death | 1 (0.9) | 4 (0.9) | 1 | 0 (0.0) | 6 (1.7) | .13 |
Birthweight (in percentiles)* | .13 | .79 | ||||
P < 10 | 6 (5.7) | 45 (10.5) | 13 (9.9) | 37 (10.9) | ||
Mode of delivery * | .76 | .34 | ||||
Spontaneous | 87 (82.1) | 366 (85.1) | 87 (65.9) | 224 (65.1) | ||
Vaginal assisted birth | 13 (12.3) | 43 (10.0) | 9 (6.8) | 38 (11.0) | ||
Caesarean section | 6 (5.7) | 21 (4.9) | 36 (27.3) | 82 (23.8) | ||
Perineum* | .26 | .03 | ||||
Not ruptured | 50 (49.0) | 216 (52.9) | 59 (60.8) | 117 (44.2) | ||
Ruptured | 28 (27.5) | 125 (30.6) | 20 (20.6) | 75 (28.3) | ||
Episiotomy | 24 (23.5) | 67 (16.4) | 18 (18.6) | 73 (27.5) | ||
Haemorrhage* | 5 (4.7) | 22 (5.2) | .84 | 7 (5.4) | 35 (10.4) | .10 |
Place of birth | .01 | .34 | ||||
Home | 5 (4.7) | 52 (12.1) | 1 (0.8) | 0 (0.0) | ||
Birth centre | 37 (36.4) | 156 (36.2) | 7 (5.3) | 14 (4.1) | ||
Hospital | 63 (58.9) | 223 (51.7) | 124 (93.9) | 331 (95.9) | ||
Transfer during labour* | 60 (56.1) | 210 (48.7) | .21 | NA | NA | |
Induction of labour* | NA | NA | 96 (73.3) | 205 (59.4) | .02 | |
Medical pain relief* | 45 (42.1) | 112 (26.0) | .01 | 79 (60.3) | 179 (52.0) | .40 |
Gestational age at onset of labour in weeks mean (sd) | 38.9 (2.6) | 39.3 (2.1) | .05 | 38.6 (1.9) | 38.7 (2.8) | .67 |
Duration of dilatation in hours median (IQR) | 8.0 (5.0–11.0) | 6.0 (4.0–9.0) | <.01 | 6.0 (4.0–9.0) | 6.0 (4.0–9.0) | .48 |
Duration of expulsion in minutes median (IQR) | 17.0 (8.8–39.0) | 15.0 (7.0–37.0) | .40 | 14.0 (7.0–32.0) | 17.0 (8.0–33.0) | .18 |
Referred pregnant women
Regression analysis of estimation of FA on obstetric and neonatal outcomes
Non-referred | Referred | |||
---|---|---|---|---|
Unadjusted n ≤ 538* | Adjusted n ≤ 538* | Unadjusted n ≤ 477* | Adjusted n ≤ 477* | |
OR (95%CI) | OR (95%CI) | OR (95%CI) | OR (95%CI) | |
Mode of delivery* | ||||
Spontaneous | ||||
Assisted birth# | 1.25 (0.71–2.19) | 1.14 (0.63–2.07) | 0.97 (0.64–1.47) | 0.94 (0.60–1.47) |
Birthweight (in percentiles)* | ||||
p ≥ 10 | ||||
p > 10 | 0.51 (0.21–1.24) | 0.51 (0.21–1.24) | 0.90 (0.46–1.76) | 0.93 (0.47–1.84) |
Perineum* | ||||
Not ruptured | ||||
Ruptured | 0.97 (0.58–1.62) | 1.05 (0.61–1.80) | 0.53 (0.30–0.95) | 0.50 (0.27–0.95) |
Episiotomy | 1.55 (0.89–2.71) | 1.53 (0.80–2.94) | 0.49 (0.27–0.89) | 0.48 (0.24–0.95) |
Haemorrhage* | ||||
No | ||||
Yes | 0.91 (0.34–2.47) | 0.97 (0.37–2.78) | 0.50 (0.21–1.15) | 0.52 (0.22–1.21) |
Place of birth Home/birth centre | ||||
Hospital | 1.34 (0.87–2.05) | 1.36 (0.87–2.12) | NA | NA |
Transfer during labour* | ||||
No | ||||
Yes | 1.34 (0.87–2.06) | 1.31 (0.85–2.03) | NA | NA |
Induction of labour* | ||||
No | ||||
Yes | NA | NA | 1.87 (1.20–2.92) | 1.86 (1.17–2.95) |
Medical pain relief* | ||||
No | ||||
Yes | 2.06 (1.34–3.20) | 1.98 (1.24–3.17) | 1.40 (0.93–2.11) | 1.38 (0.88–2.15) |
Log duration of dilatations in hours | 1.20 (1.04–1.38) | 1.20 (1.04–1.38) | 1.03 (0.87–1.21) | 1.03 (0.87–1.21) |
Log duration of expulsion in minutes | 1.06 (0.83–1.36) | 1.06 (0.83–1.36) | 0.91 (0.70–1.20) | 0.91 (0.70–1.20) |