Background
Methods
DELIVER-study
Study population
Planned place of birth and transfer of care during labour
Planned home birth: | Birth planned at home in midwife-led care. |
Planned hospital birth: | Birth planned in hospital under midwife-led care. |
Transfer: | Women who had care transferred from midwife-led to obstetrician-led during labour or immediately postpartum. |
Home – transfer: | planned home birth but transfer to obstetrician-led care during labour or immediately postpartum. |
Hosp - transfer: | planned hospital birth but transferred to secondary care during labour or immediately postpartum. |
No transfer: | Women who gave birth in midwife-led care without being transferred. |
Home - home: | birth planned at home and actual birth at home under midwife-led care |
Hosp- hosp: | planned hospital, actual hospital birth in midwife-led care |
Hosp-home: | planned hospital birth in midwife-led care, but actual home birth in midwife-led care |
Satisfaction with caregiver
Confounding factors
Potential explanatory factors
Data-analysis
Results
Planned home birth | Planned hospital birth |
p-value | |
---|---|---|---|
n = 1329 |
n = 829 | ||
Baseline characteristics | |||
Parity, n (%) | < 0.001 | ||
Primiparous | 577 (42.1) | 414 (49.9) | |
Multiparous | 795 (57.9) | 415 (50.1) | |
Gestational age, n (%) | 0.19 | ||
37 weeks | 38 (2.8) | 33 (4.0) | |
38–40 weeks | 1064 (77.6) | 648 (77.6) | |
41 weeks | 270 (19.7) | 148 (17.9) | |
Maternal age, n (%) | 0.02 | ||
< 25 years | 105 (7.7) | 74 (9.3) | |
25–35 years | 1040 (75.8) | 583 (70.3) | |
> 35 years | 227 (16.5) | 172 (20.7) | |
Ethnic background, n (%) | < 0.001 | ||
Dutch | 1244 (90.9) | 645 (78.1) | |
Western background | 74 (5.4) | 87 (10.5) | |
Non-western background | 51 (3.7) | 94 (11.4) | |
Socioeconomic position, n (%) | 0.57 | ||
1st tertile | 353 (25.8) | 228 (27.7) | |
2nd tertile | 645 (47.2) | 386 (46.8) | |
3rd tertile | 369 (27.0) | 210 (25.5) | |
Maternal outcomes and interventions | |||
Experience of labour pain, mean (sd) | |||
first stage | 7.2 (2.0) | 7.7 (1.9) | < 0.001 |
second stage | 6.9 (2.2) | 7.2 (2.2) | 0.001 |
General rating of care by caregiver, mean (sd) | 9.1 (1.1) | 8.9 (1.3) | 0.001 |
Quality of treatment, mean (sd) | 3.9 (0.3) | 3.8 (0.4) | < 0.001 |
Transfer during labour, n (% referred) | 435 (31.7) | 390 (47.0) | < 0.001 |
Medical pain reliefa, n (% yes) | 141 (10.3) | 184 (22.4) | < 0.001 |
Instrumental/ operative delivery, n (%) | 0.02 | ||
Vacuum−/ forceps extraction | 123 (9.0) | 99 (12.0) | |
Secondary caesarean section | 48 (3.5) | 39 (4.7) | |
Augmentation, n (% yes) | 205 (14.9) | 171 (20.7) | 0.001 |
Neonatal outcomes | |||
Apgar score < 7, n (%) | 8 (0.6) | 7 (0.8) | 0.47 |
Complications directly postpartum, n (%) | 21 (1.6) | 14 (1.8) | 0.72 |
Planned place of birth and satisfaction with the caregiver
Primiparous women | Multiparous women | |||||||
---|---|---|---|---|---|---|---|---|
Multilevel | Multilevel | |||||||
1: General rating of satisfaction with caregiver | Total N | N (%) ≥ 9 | OR (95% CI) | Adjusteda OR (95% CI) | Total N | N (%) ≥ 9 | OR (95% CI) | Adjusteda OR (95% CI) |
Planned home | 575 | 408 (71.0) | 1.50 (1.1, 2.0)** | 1.48 (1.1, 2.0)** | 788 | 625 (79.3) | 1.07 (0.8, 1.4) | 1.08 (0.8, 1.5) |
Planned hospital | 404 | 249 (61.6) | 1 | 1 | 406 | 317 (78.1) | 1 | 1 |
2: Quality of treatment by caregiver | N (%) =4 | N (%) =4 | ||||||
Planned home | 576 | 428 (74.3) | 1.74 (1.3, 2.3)** | 1.79 (1.3, 2.4)** | 795 | 631 (79.4) | 1.65 (1.3, 2.2)** | 1.58 (1.2, 2.1)** |
Planned hospital | 413 | 260 (63.0) | 1 | 1 | 413 | 289 (70.0) | 1 | 1 |
Primiparous women | Multiparous women | |||||||
---|---|---|---|---|---|---|---|---|
Crude | Adjusteda
| Crude | Adjusteda
| |||||
Total | No (%) always (=4) | OR (95% CI) | OR (95% CI) | Total | No (%) always (=4) | OR (95% CI) | OR (95% CI) | |
Did you feel in safe hands with the caregiver? | ||||||||
planned home | 577 | 497 (86.1) | 1.74 (1.2, 2.5)** | 1.57 (1.1, 2.3)** | 795 | 700 (88.1) | 1.56 (1.1, 2.2)** | 1.46 (1.04, 2.1)** |
planned hospital | 414 | 323 (78.0) | 1 | 1 | 413 | 341 (82.6) | 1 | 1 |
Did the caregiver explain things in an understandable way? | ||||||||
planned home | 576 | 514 (89.2) | 1.91 (1.3, 2.8)** | 1.93 (1.3, 2.9)** | 795 | 718 (90.3) | 1.43 (1.0, 2.1) | 1.32 (0.9, 1.9) |
planned hospital | 414 | 336 (81.2) | 1 | 1 | 413 | 358 (86.7) | 1 | 1 |
Did the caregiver treat you with respect? | ||||||||
planned home | 577 | 544 (94.3) | 1.36 (0.8, 2.4) | 1.27 (0.7, 2.3) | 795 | 751 (94.5) | 1.46 (0.9, 2.4) | 1.36 (0.8, 2.2) |
planned hospital | 414 | 382 (92.3) | 1 | 1 | 413 | 380 (92.0) | 1 | 1 |
Did the caregiver listen to you carefully? | ||||||||
planned home | 576 | 510 (88.5) | 1.42 (0.97, 2.1) | 1.46 (0.99, 2.1) | 795 | 720 (90.6) | 1.68 (1.2, 2.4)** | 1.57 (1.1, 2.3)** |
planned hospital | 414 | 350 (84.5) | 1 | 1 | 413 | 351 (85.0) | 1 | 1 |
Did the caregiver take you seriously? | ||||||||
planned home | 576 | 519 (90.1) | 1.57 (1.1, 2.3)** | 1.54 (1.0, 2.3)** | 795 | 741 (93.2) | 1.91 (1.3, 2.9)** | 1.76 (1.2, 2.7)** |
planned hospital | 414 | 354 (85.5) | 1 | 1 | 413 | 361 (87.4) | 1 | 1 |
Did the caregiver spent sufficient time with you? | ||||||||
planned home | 576 | 488 (84.7) | 1,49 (1.1, 2.1)** | 1,41 (0.99, 2.0) | 795 | 700 (88.1) | 1.34 (0.9, 1.9) | 1.28 (0.9, 1.8) |
planned hospital | 413 | 325 (78.7) | 1 | 1 | 413 | 347 (84.0) | 1 | 1 |
Did the caregiver give you enough opportunity to ask questions? | ||||||||
planned home | 576 | 527 (91.5) | 1,51 (0.99, 2.3) | 1,41 (0.9, 2.2) | 795 | 746 (93.8) | 1.48 (0.9, 2.3) | 1.35 (0.9, 2.2) |
planned hospital | 414 | 363 (87.7) | 1 | 1 | 413 | 375 (90.8) | 1 | 1 |
Explanatory analysis
Transfer and satisfaction with caregiver
Primiparous women | Multiparous women | |||||||
---|---|---|---|---|---|---|---|---|
Multilevel | Multilevel | |||||||
1: General rating of satisfaction with caregiver | Total N | N (%) ≥ 9 | OR (95%CI) | Adjusteda OR (95% CI) | Total N | N (%) ≥ 9 | OR (95%CI) | Adjusteda OR (95% CI) |
Transfer | ||||||||
planned home-transfer | 329 | 208 (63.2) | 1.53 (1.1, 2.2)** | 1.44 (1.0, 2.1)** | 104 | 70 (67.3) | 0.97 (0.5, 1.7) | 1.11 (0.6, 2.1) |
planned hosp-transfer | 267 | 139 (52.1) | 1 | 1 | 109 | 74 (67.9) | 1 | 1 |
No transfer | ||||||||
planned home-home | 222 | 181 (81.5) | 1.41 (0.7, 2.7) | 1.48 (0.8, 2.9) | 652 | 529 (81.1) | 1.21 (0.8, 1.8) | 1.21 (0.8, 1.8) |
planned hosp-home | 39 | 34 (87.2) | 2.14 (0.7, 6.4) | 2.04 (0.7, 6.2) | 100 | 89 (89.0) | 2.28 (1.1, 4.7)** | 2.31 (1.1, 4.7)** |
planned hosp-hosp | 98 | 76 (77.6) | 1 | 1 | 197 | 154 (78.2) | 1 | 1 |
2: Quality of treatment by caregiver | N (%) =4 | N (%) =4 | ||||||
Transfer | ||||||||
Planned home | 330 | 225 (68.2) | 1.61 (1.2, 2.2)** | 1.65 (1.2, 2.3)** | 104 | 78 (75.0) | 1.72 (0.9, 3.1) | 1.76 (0.9, 3.3) |
Planned hospital | 275 | 157 (57.1) | 1 | 1 | 113 | 72 (63.7) | 1 | 1 |
No transfer | ||||||||
planned home-home | 222 | 185 (83.3) | 1.73 (0.9, 3.2) | 1.81 (0.9, 3.4) | 659 | 530 (80.4) | 1.87 (1.3, 2.7)** | 1.80 (1.3, 2,6)** |
planned hosp-home | 39 | 29 (74.3) | 1.01 (0.4, 2.4) | 0.94 (0.4, 2.3) | 101 | 80 (79.2) | 1.74 (0.9, 3.1) | 1.70 (0.9, 3.0) |
planned hosp-hosp | 99 | 74 (74.7) | 1 | 1 | 199 | 137 (68.8) | 1 | 1 |