The first COVID-19 lockdown significantly altered maternity care practices in the Netherlands, with notable shifts in birth settings and referral patterns. This transformation in healthcare delivery, responding to unprecedented constraints, provides critical insights into the resilience of maternal care systems under crisis conditions.
Study Overview
A national quasi-experimental study analyzed data from multiple linked national registries, encompassing all births from a gestational age of 24+0 weeks between 2010 and 2020. Researchers focused on the March-June 2020 lockdown period to evaluate its impact on maternity care provision and maternal pregnancy-related outcomes. By employing a difference-in-regression-discontinuity design, causal estimates were derived specifically for the year 2020.
Key Findings
The study included a total of 1,039,728 births, revealing that during the lockdown, there was a marked increase in homebirths among women who began labor in midwife-led primary care (27% pre-lockdown, +10% during lockdown). Furthermore, referrals to obstetrician-led care during labor decreased slightly (46%, -3%). However, no significant changes were observed in the induction of labor (27%, +1%), emergency caesarean sections (9%, -1%), obstetric anal sphincter injuries (2%, +0%), episiotomies (21%, -0%), or postpartum hemorrhage (>1000 ml) (6%, -0%).
The observed increase in homebirths during the lockdown underscores the adaptability of the Dutch maternity care system, particularly its strong midwife-led primary care framework, in maintaining safe and flexible care delivery amid external disruptions. This adaptability is crucial for ensuring market access to essential maternal health services, even under crisis conditions.
Concrete Insights
Insights from the Study:
- The lockdown saw a 10% increase in homebirths, indicating a shift away from hospital settings.
- Referrals to obstetrician-led care slightly decreased by 3%, showing a potential reduction in hospital-based interventions.
- No significant changes in maternal morbidity and labor induction rates suggest stability in overall maternal outcomes despite the lockdown.
These findings highlight the importance of a robust primary care system in maintaining service continuity and accessibility during health crises.
In conclusion, the first COVID-19 lockdown in the Netherlands led to a notable increase in homebirths without adversely affecting maternal outcomes. This demonstrates the capacity of a well-structured maternity care system to adapt and ensure consistent care delivery during times of significant disruption.
Original Article: Public Health. 2024 Jul 20;235:15-25. doi: 10.1016/j.puhe.2024.06.024. Online ahead of print.
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