Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands: A national quasi-experimental study

B. Gravesteijn; N.W. Boderie; T. van den Akker; L.C.M. Bertens; K. Bloemenkamp; L. Burgos Ochoa; Ank De Jonge; B.M. Kazemier; P.P. Klein; I. Kwint-Reijnders; J.A. Labrecque; B.W. Mol; Sylvia Obermann-Borst; Lilian L Peters; Anita Ravelli; A. Rosman; Jasper Been; Christianne de Groot; E. Ambrosino; K.V. Auweele; J. Been; R. Beijers; L. Bertens; K. Bloemenkamp; N. Boderie; L. Burdorf; L.B. Ochoa; A. de Jonge; C. de Weerth; A. Franx; S. Harper; B.M. Kazemier; P.P. Klein; D. Kretz; J. Labrecque; B.W. Mol; J. Muris; M. Nieuwenhuijze; S. Obermann; M. Oudijk; L. Peters; L. Ramerman; A. Ravelli; A. Schonewille-Rosman; J. Struijs; H. Torij; M. Van Beukering; T. van den Akker; M. van den Heuvel; J. van Dillen; F. van Lenthe; R. Verheij

doi:10.1016/j.puhe.2024.06.024

Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands: A national quasi-experimental study

B. Gravesteijn^*, N.W. Boderie, T. van den Akker, L.C.M. Bertens, K. Bloemenkamp, L. Burgos Ochoa, Ank De Jonge, B.M. Kazemier, P.P. Klein, I. Kwint-Reijnders, J.A. Labrecque, B.W. Mol, Sylvia Obermann-Borst, Lilian L Peters, Anita Ravelli, A. Rosman, Jasper Been, Christianne de Groot, E. Ambrosino, K.V. AuweeleJ. Been, R. Beijers, L. Bertens, K. Bloemenkamp, N. Boderie, L. Burdorf, L.B. Ochoa, A. de Jonge, C. de Weerth, A. Franx, S. Harper, B.M. Kazemier, P.P. Klein, D. Kretz, J. Labrecque, B.W. Mol, J. Muris, M. Nieuwenhuijze, S. Obermann, M. Oudijk, L. Peters, L. Ramerman, A. Ravelli, A. Schonewille-Rosman, J. Struijs, H. Torij, M. Van Beukering, T. van den Akker, M. van den Heuvel, J. van Dillen, F. van Lenthe, R. Verheij

^*Corresponding author for this work

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Abstract

Objectives
The COVID-19 pandemic and associated lockdowns disrupted health care worldwide. High-income countries observed a decrease in preterm births during lockdowns, but maternal pregnancy–related outcomes were also likely affected. This study investigates the effect of the first COVID-19 lockdown (March–June 2020) on provision of maternity care and maternal pregnancy–related outcomes in the Netherlands.

Study design
National quasi-experimental study.

Methods
Multiple linked national registries were used, and all births from a gestational age of 24+0 weeks in 2010–2020 were included. In births starting in midwife-led primary care, we assessed the effect of lockdown on provision of care. In the general pregnant population, the impact on characteristics of labour and maternal morbidity was assessed. A difference-in-regression-discontinuity design was used to derive causal estimates for the year 2020.

Results
A total of 1,039,728 births were included. During the lockdown, births to women who started labour in midwife-led primary care (49%) more often ended at home (27% pre-lockdown, +10% [95% confidence interval: +7%, +13%]). A small decrease was seen in referrals towards obstetrician-led care during labour (46%, −3% [−5%,−0%]). In the overall group, no significant change was seen in induction of labour (27%, +1% [−1%, +3%]). We found no significant changes in the incidence of emergency caesarean section (9%, −1% [−2%, +0%]), obstetric anal sphincter injury (2%, +0% [−0%, +1%]), episiotomy (21%, −0% [−2%, +1%]), or post-partum haemorrhage: >1000 ml (6%, −0% [−1%, +1%]).

Conclusions
During the first COVID-19 lockdown in the Netherlands, a substantial increase in homebirths was seen. There was no evidence for changed available maternal outcomes, suggesting that a maternity care system with a strong midwife-led primary care system may flexibly and safely adapt to external disruptions.

Original language	English
Pages (from-to)	15-25
Number of pages	11
Journal	Public Health
Volume	235
DOIs	https://doi.org/10.1016/j.puhe.2024.06.024
Publication status	Published - Oct 2024

Keywords

COVID-19
Homebirth
Maternal health
Natural experiment
SARS-CoV−2

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Gravesteijn, B., Boderie, N. W., van den Akker, T., Bertens, L. C. M., Bloemenkamp, K., Ochoa, L. B., Jonge, A. D., Kazemier, B. M., Klein, P. P., Kwint-Reijnders, I., Labrecque, J. A., Mol, B. W., Obermann-Borst, S., Peters, L. L., Ravelli, A., Rosman, A., Been, J., de Groot, C., Ambrosino, E., ... Verheij, R. (2024). Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands: A national quasi-experimental study. Public Health, 235, 15-25. https://doi.org/10.1016/j.puhe.2024.06.024

@article{7607e84f6f5b4030b4a71c6680cf446f,

title = "Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands: A national quasi-experimental study",

abstract = "ObjectivesThe COVID-19 pandemic and associated lockdowns disrupted health care worldwide. High-income countries observed a decrease in preterm births during lockdowns, but maternal pregnancy–related outcomes were also likely affected. This study investigates the effect of the first COVID-19 lockdown (March–June 2020) on provision of maternity care and maternal pregnancy–related outcomes in the Netherlands.Study designNational quasi-experimental study.MethodsMultiple linked national registries were used, and all births from a gestational age of 24+0 weeks in 2010–2020 were included. In births starting in midwife-led primary care, we assessed the effect of lockdown on provision of care. In the general pregnant population, the impact on characteristics of labour and maternal morbidity was assessed. A difference-in-regression-discontinuity design was used to derive causal estimates for the year 2020.ResultsA total of 1,039,728 births were included. During the lockdown, births to women who started labour in midwife-led primary care (49%) more often ended at home (27% pre-lockdown, +10% [95% confidence interval: +7%, +13%]). A small decrease was seen in referrals towards obstetrician-led care during labour (46%, −3% [−5%,−0%]). In the overall group, no significant change was seen in induction of labour (27%, +1% [−1%, +3%]). We found no significant changes in the incidence of emergency caesarean section (9%, −1% [−2%, +0%]), obstetric anal sphincter injury (2%, +0% [−0%, +1%]), episiotomy (21%, −0% [−2%, +1%]), or post-partum haemorrhage: >1000 ml (6%, −0% [−1%, +1%]).ConclusionsDuring the first COVID-19 lockdown in the Netherlands, a substantial increase in homebirths was seen. There was no evidence for changed available maternal outcomes, suggesting that a maternity care system with a strong midwife-led primary care system may flexibly and safely adapt to external disruptions.",

keywords = "COVID-19, Homebirth, Maternal health, Natural experiment, SARS-CoV−2",

author = "B. Gravesteijn and N.W. Boderie and {van den Akker}, T. and L.C.M. Bertens and K. Bloemenkamp and Ochoa, {L. Burgos} and Jonge, {Ank De} and B.M. Kazemier and P.P. Klein and I. Kwint-Reijnders and J.A. Labrecque and B.W. Mol and Sylvia Obermann-Borst and Peters, {Lilian L} and Anita Ravelli and A. Rosman and Jasper Been and {de Groot}, Christianne and E. Ambrosino and K.V. Auweele and J. Been and R. Beijers and L. Bertens and K. Bloemenkamp and N. Boderie and L. Burdorf and L.B. Ochoa and {de Jonge}, A. and {de Weerth}, C. and A. Franx and S. Harper and B.M. Kazemier and P.P. Klein and D. Kretz and J. Labrecque and B.W. Mol and J. Muris and M. Nieuwenhuijze and S. Obermann and M. Oudijk and L. Peters and L. Ramerman and A. Ravelli and A. Schonewille-Rosman and J. Struijs and H. Torij and Beukering, {M. Van} and {van den Akker}, T. and {van den Heuvel}, M. and {van Dillen}, J. and {van Lenthe}, F. and R. Verheij",

year = "2024",

month = oct,

doi = "10.1016/j.puhe.2024.06.024",

language = "English",

volume = "235",

pages = "15--25",

journal = "Public Health",

issn = "0033-3506",

publisher = "Elsevier B.V.",

}

Gravesteijn, B, Boderie, NW, van den Akker, T, Bertens, LCM, Bloemenkamp, K, Ochoa, LB, Jonge, AD, Kazemier, BM, Klein, PP, Kwint-Reijnders, I, Labrecque, JA, Mol, BW, Obermann-Borst, S, Peters, LL, Ravelli, A, Rosman, A, Been, J, de Groot, C, Ambrosino, E, Auweele, KV, Been, J, Beijers, R, Bertens, L, Bloemenkamp, K, Boderie, N, Burdorf, L, Ochoa, LB, de Jonge, A, de Weerth, C, Franx, A, Harper, S, Kazemier, BM, Klein, PP, Kretz, D, Labrecque, J, Mol, BW, Muris, J, Nieuwenhuijze, M, Obermann, S, Oudijk, M, Peters, L, Ramerman, L, Ravelli, A, Schonewille-Rosman, A, Struijs, J, Torij, H, Beukering, MV, van den Akker, T, van den Heuvel, M, van Dillen, J, van Lenthe, F & Verheij, R 2024, 'Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands: A national quasi-experimental study', Public Health, vol. 235, pp. 15-25. https://doi.org/10.1016/j.puhe.2024.06.024

TY - JOUR

T1 - Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands

T2 - A national quasi-experimental study

AU - Gravesteijn, B.

AU - Boderie, N.W.

AU - van den Akker, T.

AU - Bertens, L.C.M.

AU - Bloemenkamp, K.

AU - Ochoa, L. Burgos

AU - Jonge, Ank De

AU - Kazemier, B.M.

AU - Klein, P.P.

AU - Kwint-Reijnders, I.

AU - Labrecque, J.A.

AU - Mol, B.W.

AU - Obermann-Borst, Sylvia

AU - Peters, Lilian L

AU - Ravelli, Anita

AU - Rosman, A.

AU - Been, Jasper

AU - de Groot, Christianne

AU - Ambrosino, E.

AU - Auweele, K.V.

AU - Been, J.

AU - Beijers, R.

AU - Bertens, L.

AU - Bloemenkamp, K.

AU - Boderie, N.

AU - Burdorf, L.

AU - Ochoa, L.B.

AU - de Jonge, A.

AU - de Weerth, C.

AU - Franx, A.

AU - Harper, S.

AU - Kazemier, B.M.

AU - Klein, P.P.

AU - Kretz, D.

AU - Labrecque, J.

AU - Mol, B.W.

AU - Muris, J.

AU - Nieuwenhuijze, M.

AU - Obermann, S.

AU - Oudijk, M.

AU - Peters, L.

AU - Ramerman, L.

AU - Ravelli, A.

AU - Schonewille-Rosman, A.

AU - Struijs, J.

AU - Torij, H.

AU - Beukering, M. Van

AU - van den Akker, T.

AU - van den Heuvel, M.

AU - van Dillen, J.

AU - van Lenthe, F.

AU - Verheij, R.

PY - 2024/10

Y1 - 2024/10

N2 - ObjectivesThe COVID-19 pandemic and associated lockdowns disrupted health care worldwide. High-income countries observed a decrease in preterm births during lockdowns, but maternal pregnancy–related outcomes were also likely affected. This study investigates the effect of the first COVID-19 lockdown (March–June 2020) on provision of maternity care and maternal pregnancy–related outcomes in the Netherlands.Study designNational quasi-experimental study.MethodsMultiple linked national registries were used, and all births from a gestational age of 24+0 weeks in 2010–2020 were included. In births starting in midwife-led primary care, we assessed the effect of lockdown on provision of care. In the general pregnant population, the impact on characteristics of labour and maternal morbidity was assessed. A difference-in-regression-discontinuity design was used to derive causal estimates for the year 2020.ResultsA total of 1,039,728 births were included. During the lockdown, births to women who started labour in midwife-led primary care (49%) more often ended at home (27% pre-lockdown, +10% [95% confidence interval: +7%, +13%]). A small decrease was seen in referrals towards obstetrician-led care during labour (46%, −3% [−5%,−0%]). In the overall group, no significant change was seen in induction of labour (27%, +1% [−1%, +3%]). We found no significant changes in the incidence of emergency caesarean section (9%, −1% [−2%, +0%]), obstetric anal sphincter injury (2%, +0% [−0%, +1%]), episiotomy (21%, −0% [−2%, +1%]), or post-partum haemorrhage: >1000 ml (6%, −0% [−1%, +1%]).ConclusionsDuring the first COVID-19 lockdown in the Netherlands, a substantial increase in homebirths was seen. There was no evidence for changed available maternal outcomes, suggesting that a maternity care system with a strong midwife-led primary care system may flexibly and safely adapt to external disruptions.

AB - ObjectivesThe COVID-19 pandemic and associated lockdowns disrupted health care worldwide. High-income countries observed a decrease in preterm births during lockdowns, but maternal pregnancy–related outcomes were also likely affected. This study investigates the effect of the first COVID-19 lockdown (March–June 2020) on provision of maternity care and maternal pregnancy–related outcomes in the Netherlands.Study designNational quasi-experimental study.MethodsMultiple linked national registries were used, and all births from a gestational age of 24+0 weeks in 2010–2020 were included. In births starting in midwife-led primary care, we assessed the effect of lockdown on provision of care. In the general pregnant population, the impact on characteristics of labour and maternal morbidity was assessed. A difference-in-regression-discontinuity design was used to derive causal estimates for the year 2020.ResultsA total of 1,039,728 births were included. During the lockdown, births to women who started labour in midwife-led primary care (49%) more often ended at home (27% pre-lockdown, +10% [95% confidence interval: +7%, +13%]). A small decrease was seen in referrals towards obstetrician-led care during labour (46%, −3% [−5%,−0%]). In the overall group, no significant change was seen in induction of labour (27%, +1% [−1%, +3%]). We found no significant changes in the incidence of emergency caesarean section (9%, −1% [−2%, +0%]), obstetric anal sphincter injury (2%, +0% [−0%, +1%]), episiotomy (21%, −0% [−2%, +1%]), or post-partum haemorrhage: >1000 ml (6%, −0% [−1%, +1%]).ConclusionsDuring the first COVID-19 lockdown in the Netherlands, a substantial increase in homebirths was seen. There was no evidence for changed available maternal outcomes, suggesting that a maternity care system with a strong midwife-led primary care system may flexibly and safely adapt to external disruptions.

KW - COVID-19

KW - Homebirth

KW - Maternal health

KW - Natural experiment

KW - SARS-CoV−2

UR - http://www.scopus.com/inward/record.url?scp=85199061463&partnerID=8YFLogxK

U2 - 10.1016/j.puhe.2024.06.024

DO - 10.1016/j.puhe.2024.06.024

M3 - Article

SN - 0033-3506

VL - 235

SP - 15

EP - 25

JO - Public Health

JF - Public Health

ER -

Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands: A national quasi-experimental study

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Keywords

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