Open AccessIntrapartum and neonatal mortality in low‐risk term women in midwife‐led care and obstetrician‐led care at the onset of labor: A national matched cohort study
Author(s) -
Wiegerinck Melanie M. J.,
Eskes Martine,
Post Joris A. M.,
Mol Ben W.,
Ravelli Anita C. J.
Publication year - 2020
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.13767
Subject(s) - medicine , obstetrics , obstetrics and gynaecology , pregnancy , apgar score , odds ratio , cohort , propensity score matching , cohort study , gestational age , surgery , genetics , biology
Midwife‐led models of care have been the subject of debate for many years. We conducted a study to compare intrapartum and neonatal mortality rates in midwife‐led (primary) vs obstetrician‐led (secondary) care at the onset of labor in low‐risk term women. Material and methods We performed an unmatched and a propensity score matched cohort study using data from the national perinatal audit registry (PAN) and from the national perinatal registry (PERINED) of the Netherlands. We included women with singleton pregnancies (without congenital anomalies or antepartum fetal death) who gave birth at term between 2010 and 2012. We excluded the following major risk factors: non‐vertex position of the fetus, previous cesarean birth, hypertension, diabetes mellitus, prolonged rupture of membranes (≥24 hours), vaginal bleeding in the second half of pregnancy, nonspontaneous start of labor and post‐term pregnancy (≥42 weeks). The primary outcome was intrapartum or neonatal mortality up to 28 days after birth. Secondary outcome measures were mode of delivery and a 5‐minute Apgar score <7. Results We included 259 211 women. There were 100/206 642 (0.48‰) intrapartum and neonatal deaths in the midwife group and 23/52 569 (0.44‰) in the obstetrician group (odds ratio [OR] 1.11, 95% CI 0.70‐1.74). Propensity score matched analysis showed mortality rates of 0.49‰ (26/52 569) among women in midwife‐led care and 0.44‰ (23/52 569) for women in obstetrician‐led care (OR 1.13, 95% CI 0.65‐1.98). In the midwife group there were significantly lower rates of vaginal instrumental deliveries (8.4% vs 13.0%; matched OR 0.65, 95% CI 0.62‐0.67) and intrapartum cesarean sections (2.6% vs 8.2%; matched OR 0.32, 95% CI 0.30‐0.34), and fewer neonates with low Apgar scores (<7 after 5 minutes) (0.69% vs 1.11%; matched OR 0.61, 95% CI 0.53‐0.69). Conclusions Among low‐risk term women, there were comparable intrapartum and neonatal mortality rates for women starting labor in midwife‐led vs obstetrician‐led care, with lower intervention rates and fewer low Apgar scores in the midwife group.