Background
Methods
Data
Determinants
Outcome measures
Casemix adjustment
Statistical analysis
Variable | Planned home birth | Planned hospital birth | Planned place unknown | |||
---|---|---|---|---|---|---|
n | % | n | % | n | % | |
402,912 | 59% | 219,105 | 32% | 57,935 | 9% | |
Parity** | ||||||
Primiparous | 171,986 | 42,7% | 104,249 | 47,6% | 26,254 | 45,3% |
Multiparous (REF) | 230,926 | 57,3% | 114,856 | 52,4% | 31,681 | 54,7% |
Maternal Age** | ||||||
< 19 years | 4036 | 1,0% | 6713 | 3,1% | 1190 | 2,1% |
20–25 years | 34,661 | 8,6% | 32,617 | 14,9% | 6823 | 11,8% |
25–34 years (REF) | 296,128 | 73,5% | 142,597 | 65,1% | 39,526 | 68,2% |
> 35 years | 68,087 | 16,9% | 37,178 | 17,0% | 10,396 | 17,9% |
Ethnic background** | ||||||
Dutch (REF) | 370,647 | 92,0% | 153,572 | 70,1% | 46,966 | 81,1% |
Non Dutch | 32,265 | 8,0% | 65,533 | 29,9% | 10,969 | 18,9% |
Neighbourhood** | ||||||
Privileged neighbourhood (REF) | 388,089 | 96,3% | 196,659 | 89,8% | 53,823 | 92,9% |
Underprivileged neighbourhood | 14,823 | 3,7% | 22,446 | 10,2% | 4112 | 7,1% |
Gestational Age** | ||||||
< 34wk | 2396 | 0,6% | 1658 | 0,8% | 567 | 1,0% |
35-36wk | 6510 | 1,6% | 4064 | 1,9% | 1206 | 2,1% |
37wk | 15,203 | 3,8% | 9603 | 4,4% | 2497 | 4,3% |
38-41wk (REF) | 372,787 | 92,5% | 200,872 | 91,7% | 52,899 | 91,3% |
> 41 wk | 6016 | 1,5% | 2908 | 1,3% | 766 | 1,3% |
Big4** | ||||||
SGA | 28,029 | 7,0% | 18,288 | 8,3% | 4364 | 7,5% |
Prematurity | 8056 | 2,0% | 5194 | 2,4% | 1583 | 2,7% |
Low apgar | 1642 | 0,4% | 1171 | 0,5% | 290 | 0,5% |
Congenital abnomality | 4711 | 1,2% | 2826 | 1,3% | 759 | 1,3% |
Combination Big4 | 1895 | 0,5% | 1326 | 0,6% | 373 | 0,6% |
No Big4 | 358,579 | 89,0% | 190,300 | 86,9% | 50,566 | 87,3% |
Time of delivery** | ||||||
Day 8.00–18.00 (REF) | 167,345 | 41,5% | 96,033 | 43,8% | 24,674 | 42,6% |
Night 18.00–8.00 | 235,567 | 58,5% | 123,072 | 56,2% | 33,261 | 57,4% |
Day of delivery** | ||||||
Weekend | 109,761 | 27,2% | 59,976 | 27,4% | 15,553 | 26,8% |
Week day (REF) | 293,151 | 72,8% | 159,129 | 72,6% | 42,382 | 73,2% |
Interventions** | ||||||
Vacuum extraction/forceps | 32,481 | 8,1% | 20,404 | 9,3% | 4630 | 8,0% |
Section cesarean | 11,285 | 2,8% | 9731 | 4,4% | 2412 | 4,2% |
No vacuum/forceps or section cesarean | 359,146 | 89,1% | 188,970 | 86,2% | 50,893 | 87,8% |
Intrapartum & early neonatal death (7 days)** | ||||||
No | 402,266 | 99,8% | 218,672 | 99,8% | 57,826 | 99,8% |
Yes | 594 | 0,15% | 403 | 0,18% | 102 | 0,18% |
Results
Intervention rates
TOTAL(n) | IV (N) | % |
p
| Model 1 |
p
| Model 2 |
p
| |||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Crude RR | 95% CI | Adj OR | 95% CI | |||||||||
Intended place of birth | ** | ** | ** | |||||||||
Home | 402,912 | 43,766 | 0,109 | 0,76 | 0,75 | 0,78 | 0,77 | 0,75 | 0,78 | |||
Hospital (REF) | 219,105 | 30,135 | 0,138 | 1 | 1 | |||||||
Unknown | 57,935 | 7042 | 0,122 | 0,87 | 0,84 | 0,89 | 0,86 | 0,84 | 0,89 | |||
Parity | ** | ** | ** | |||||||||
Primiparous | 302,489 | 70,334 | 0,233 | 10,49 | 10,27 | 10,71 | 11,90 | 11,64 | 12,16 | |||
Multiparous (REF) | 377,463 | 10,609 | 0,028 | 1 | 1 | |||||||
Maternal Age | ** | ** | ** | |||||||||
< 19 years | 11,939 | 1295 | 0,108 | 0,86 | 0,81 | 0,91 | 0,40 | 0,37 | 0,42 | |||
20–25 years | 74,101 | 8737 | 0,118 | 0,94 | 0,92 | 0,96 | 0,58 | 0,57 | 0,60 | |||
25–34 years (REF) | 478,251 | 59,536 | 0,124 | 1 | 1 | |||||||
> 35 years | 115,661 | 11,375 | 0,098 | 0,77 | 0,75 | 0,78 | 1,36 | 1,33 | 1,40 | |||
Ethnic background | ** | ** | ** | |||||||||
Dutch (REF) | 571,185 | 69,983 | 0,123 | 1 | 1 | |||||||
Non Dutch | 108,767 | 10,960 | 0,101 | 0,80 | 0,79 | 0,82 | 0,96 | 0,94 | 0,99 | |||
Neighbourhood | ** | ** | ** | |||||||||
Privileged neighbourhood (REF) | 638,571 | 76,646 | 0,120 | 1 | 1 | |||||||
Underprivileged neighbourhood | 41,381 | 4297 | 0,104 | 0,85 | 0,82 | 0,88 | 0,90 | 0,87 | 0,94 | |||
Gestational Age | ** | ** | ** | |||||||||
< 34wk | 4621 | 873 | 0,189 | 1,90 | 1,76 | 2,04 | 1,02 | 0,94 | 1,10 | |||
35-36wk | 11,780 | 1926 | 0,163 | 1,48 | 1,41 | 1,55 | 0,96 | 0,91 | 1,01 | |||
37wk | 27,303 | 2701 | 0,099 | 0,83 | 0,80 | 0,86 | 0,63 | 0,61 | 0,66 | |||
38-41wk (REF) | 626,558 | 73,286 | 0,117 | 1 | 1 | |||||||
> 41 wk | 9690 | 2157 | 0,223 | 2,16 | 2,06 | 2,27 | 2,11 | 2,00 | 2,22 | |||
Big3 | ** | ** | ** | |||||||||
SGA | 50,681 | 5169 | 0,102 | 0,83 | 0,81 | 0,85 | 0,85 | 0,82 | 0,87 | |||
Prematurity | 16,401 | 2799 | 0,350 | |||||||||
Congenital abnomality | 3594 | 904 | 0,252 | 1,86 | 1,76 | 1,97 | 1,77 | 1,67 | 1,88 | |||
Combination Big3 | 2443 | 507 | 0,140 | 2,64 | 2,44 | 2,85 | 1,66 | 1,49 | 1,85 | |||
No Big3 | 606,833 | 71,564 | 0,118 | 1 | 1 | |||||||
Time of delivery | ** | ** | ||||||||||
Day 8.00–18.00 (REF) | 288,052 | 38,414 | 0,133 | 1 | 1 | |||||||
Night 18.00–8.00 | 391,900 | 42,529 | 0,109 | 0,79 | 0,78 | 0,80 | 0,86 | 0,84 | 0,87 | |||
Day of delivery | ** | |||||||||||
Week day (REF) | 494,662 | 58,785 | 0,119 | 1 | nie | |||||||
Weekend | 185,290 | 22,158 | 0,120 | 1,01 | 0,99 | 1,02 |
Perinatal mortality
TOTAL(n) | mortality (n) | % |
p
| Model 1 |
p
| Model 2 |
p
| |||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Crude RR | 95% CI | Adj OR | 95% CI | |||||||||
Intended place of birth | ** | ** | nie | |||||||||
Home | 402,912 | 646 | 0,16% | ,80 | ,71 | ,91 | ||||||
Hospital (REF) | 219,105 | 433 | 0,20% | 1,00 | ||||||||
Unknown | 57,935 | 109 | 0,19% | ,96 | ,77 | 1,19 | ||||||
Parity | ** | ** | nie | |||||||||
Primiparous | 302,489 | 667 | 0,22% | 1,58 | 1,40 | 1,78 | ||||||
Multiparous (REF) | 377,463 | 521 | 0,14% | 1 | ||||||||
Maternal Age | ** | ** | ** | |||||||||
< 19 years | 11,939 | 44 | 0,37% | 2,43 | 1,78 | 3,32 | 1,79 | 1,26 | 2,54 | |||
20–25 years | 74,101 | 146 | 0,20% | 1,24 | 1,03 | 1,49 | 0,99 | 0,80 | 1,21 | |||
25–34 years (REF) | 478,251 | 753 | 0,16% | 1 | 1 | |||||||
> 35 years | 115,661 | 245 | 0,21% | 1,38 | 1,19 | 1,60 | 1,50 | 1,28 | 1,76 | |||
Ethnic background | ** | ** | ** | |||||||||
Dutch (REF) | 571,185 | 953 | 0,17% | 1 | 1 | |||||||
Non Dutch | 108,767 | 235 | 0,22% | 1,31 | 1,13 | 1,52 | 1,29 | 1,09 | 1,53 | |||
Neighbourhood | ** | |||||||||||
Privileged neighbourhood (REF) | 638,571 | 1113 | 0,17% | 1 | 1,00 | |||||||
Underprivileged neighbourhood | 41,381 | 75 | 0,18% | 1,02 | 0,80 | 1,30 | 0,70 | 0,53 | 0,93 | |||
Gestational Age | ** | ** | ** | |||||||||
< 34wk | 4621 | 378 | 8,18% | 87,01 | 76,10 | 99,48 | 27,71 | 22,58 | 34,01 | |||
35-36wk | 11,780 | 72 | 0,61% | 5,73 | 4,43 | 7,41 | 2,35 | 1,75 | 3,17 | |||
37wk | 27,303 | 61 | 0,22% | 2,12 | 1,61 | 2,79 | 2,04 | 1,55 | 2,69 | |||
38-41wk (REF) | 626,558 | 663 | 0,11% | 1 | 1 | |||||||
> 41 wk | 9690 | 14 | 0,14% | 1,39 | 0,80 | 2,40 | 1,15 | 0,66 | 2,00 | |||
Big4 | ** | ** | ||||||||||
SGA | 50,681 | 81 | 0,16% | 0,96 | 0,76 | 1,21 | 2,45 | 1,92 | 3,12 | |||
Low apgar | 3103 | 111 | 3,58% | 22,02 | 17,84 | 27,18 | ** | 47,56 | 37,95 | 59,61 | ||
Congenital abnomality | 8296 | 90 | 1,08% | 5,46 | 4,28 | 6,97 | ** | 12,46 | 9,64 | 16,10 | ||
Combination Big4 | 3594 | 420 | 11,69% | 115,01 | 101,14 | 130,77 | ** | 35,96 | 29,46 | 43,90 | ||
No Big4 | 599,445 | 309 | 0,05% | 1 | 1 | |||||||
Time of delivery | nie | nie | nie | |||||||||
Day 8.00–18.00 (REF) | 288,052 | 499 | 0,17% | 1 | ||||||||
Night 18.00–8.00 | 391,900 | 689 | 0,18% | 1,02 | 0,91 | 1,16 | ||||||
Day of delivery | nie | nie | nie | |||||||||
Week day (REF) | 494,662 | 841 | 0,17% | 1 | ||||||||
Weekend | 185,290 | 347 | 0,19% | 1,12 | 0,98 | 1,28 | ||||||
Intervention*intended place of birth | ||||||||||||
Home intervention | 2,14 | 1,80 | 2,56 | 1,51 | 1,25 | 1,84 | ||||||
Home no intervention | 0,63 | 0,56 | 0,71 | nie | ||||||||
Hospital intervention | 2,07 | 1,68 | 2,55 | nie | ||||||||
Hospital no intervention (REF) | 1 | 1 | ||||||||||
Unknown intervention | 1,77 | 1,14 | 2,76 | nie | ||||||||
Unknown no intervention | 1,00 | 0,80 | 1,25 | nie |
No Intervention group | Intervention Group | |||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Total | N | Mortality* | Mortality Rate | N | Mortality* | Mortality Rate | Interven tion rate ratio** | Mortali Ty Rate Ratio No Interven Tion Group*** | Mortali Ty Rate Ratio Interven Tion Group**** | |||||||||
Pattern | Home + Hospital | Home | Hospital | Home | Hospital | Home | Hospital | Home | Hospital | Home | Hospital | Home | Hospital | Home vs hospital | Home Vs Hospital | Home Vs Hospital | ||
1 | NOBIG3 | P0 | 242,184 | 116,663 | 68,641 | 123 | 78 | 0,11% | 0,11% | 35,179 | 21,701 | 63 | 52 | 0,18% | 0,24% | 0,95 | 0,93 | 0,75 |
4 | P1 | 310,398 | 205,324 | 96,889 | 127 | 74 | 0,06% | 0,08% | 3582 | 4603 | 27 | 14 | 0,75% | 0,30% | 0,37 | 0,81 | 2,48 | |
3 | SGA | P0 | 20,071 | 9186 | 6799 | 16 | 13 | 0,17% | 0,19% | 2335 | 1751 | 13 | 5 | 0,56% | 0,29% | 0,99 | 0,91 | 1,95 |
8 | P1 | 26,187 | 16,188 | 9377 | 16 | 7 | 0,10% | 0,07% | 281 | 341 | 3 | 1 | 1,07% | 0,29% | 0,48 | 1,32 | 3,64 | |
3 | PREMATURE BIRTH | P0 | 8752 | 4366 | 2582 | 41 | 36 | 0,94% | 1,39% | 1088 | 716 | 6 | 1 | 0,55% | 0,14% | 0,90 | 0,67 | 3,95 |
2 | P1 | 4278 | 2339c | 1592 | 18 | 30 | 0,77% | 1,88% | 152 | 195 | 3 | 4 | 1,97% | 2,05% | 0,53 | 0,41 | 0,96 | |
7 | CONGENITAL ANOMALY | P0 | 3785 | 1511 | 957 | 12 | 6 | 0,79% | 0,63% | 815 | 502 | 9 | 5 | 1,10% | 1,00% | 1,03 | 1,27 | 1,11 |
4 | P1 | 3740 | 2300 | 1253 | 20 | 11 | 0,87% | 0,88% | 78 | 109 | 1 | 1 | 1,28% | 0,92% | 0,39 | 0,99 | 1,40 | |
1 | COMBINATION BIG3 | P0 | 1134 | 487 | 318 | 34 | 23 | 6,98% | 7,23% | 186 | 143 | 10 | 10 | 5,38% | 6,99% | 0,85 | 0,97 | 0,77 |
8 | P1 | 912 | 487 | 314 | 46 | 29 | 9,45% | 9,24% | 54 | 57 | 6 | 3 | 11,11% | 5,26% | 0,61 | 1,02 | 2,11 | |
COLUMN | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 |