Mode of birth and medical interventions among women at low risk of complications: A cross-national comparison of birth settings in England and the Netherlands

<div><p>Objectives</p><p>To compare mode of birth and medical interventions between broadly equivalent birth settings in England and the Netherlands.</p><p>Methods</p><p>Data were combined from the Birthplace study in England (from April 2008 to April 2010) and the National Perinatal Register in the Netherlands (2009). Low risk women in England planning birth at home (16,470) or in freestanding midwifery units (11,133) were compared with Dutch women with planned home births (40,468). Low risk English women with births planned in alongside midwifery units (16,418) or obstetric units (19,096) were compared with Dutch women with planned midwife-led hospital births (37,887).</p><p>Results</p><p>CS rates varied across planned births settings from 6.5% to 15.5% among nulliparous and 0.6% to 5.1% among multiparous women. CS rates were higher among low risk nulliparous and multiparous English women planning obstetric unit births compared to Dutch women planning midwife-led hospital births (adjusted (adj) OR 1.89 (95% CI 1.64 to 2.18) and 3.66 (2.90 to 4.63) respectively).</p><p>Instrumental vaginal birth rates varied from 10.7% to 22.5% for nulliparous and from 0.9% to 5.7% for multiparous women. Rates were lower in the English comparison groups apart from planned births in obstetric units. Transfer, augmentation and episiotomy rates were much lower in England compared to the Netherlands for all midwife-led groups. In most comparisons, epidural rates were higher among English groups.</p><p>Conclusions</p><p>When considering maternal outcomes, findings confirm advantages of giving birth in midwife-led settings for low risk women. Further research is needed into strategies to decrease rates of medical intervention in obstetric units in England and to reduce rates of avoidable transfer, episiotomy and augmentation of labour in the Netherlands.</p></div

Planned place of birth and rate of caesarean section.

<p>Planned place of birth and rate of caesarean section.</p

Planned place of birth and rate of operative births (caesarean section or instrumental vaginal birth).

<p>Planned place of birth and rate of operative births (caesarean section or instrumental vaginal birth).</p

Augmentation with oxytocin, epidural or spinal analgesia and transfer of care.

<p>Augmentation with oxytocin, epidural or spinal analgesia and transfer of care.</p

Planned place of birth and rate of instrumental vaginal birth (ventouse or forceps).

<p>Planned place of birth and rate of instrumental vaginal birth (ventouse or forceps).</p

The golden hour of sepsis: An in-depth analysis of sepsis-related maternal mortality in middle-income country Suriname

<div><p>Background</p><p>Sepsis was the main cause of maternal mortality in Suriname, a middle-income country. Objective of this study was to perform a qualitative analysis of the clinical and management aspects of sepsis-related maternal deaths with a focus on the ‘golden hour’ principle of antibiotic therapy.</p><p>Methods</p><p>A nationwide reproductive age mortality survey was performed from 2010 to 2014 to identify and audit all maternal deaths in Suriname. All sepsis-related deaths were reviewed by a local expert committee to assess socio-demographic characteristics, clinical aspects and substandard care.</p><p>Results</p><p>Of all 65 maternal deaths in Suriname 29 (45%) were sepsis-related. These women were mostly of low socio-economic class (n = 23, 82%), of Maroon ethnicity (n = 14, 48%) and most deaths occurred postpartum (n = 21, 72%). Underlying causes were pneumonia (n = 14, 48%), wound infections (n = 3, 10%) and endometritis (n = 3, 10%). Bacterial growth was detected in 10 (50%) of the 20 available blood cultures. None of the women with sepsis as underlying cause of death received antibiotic treatment within the first hour, although most women fulfilled the diagnostic criteria of sepsis upon admission. In 27 (93%) of the 29 women from which sufficient information was available, substandard care factors were identified: delay in monitoring in 16 (59%) women, in diagnosis in 17 (63%) and in treatment in 21 (78%).</p><p>Conclusion</p><p>In Suriname, a middle-income country, maternal mortality could be reduced by improving early recognition and timely diagnosis of sepsis, vital signs monitoring and immediate antibiotic infusion (within the golden hour).</p></div

Baseline characteristics of low risk women at the start of labour by country specific birth setting.

<p>Baseline characteristics of low risk women at the start of labour by country specific birth setting.</p

Third of fourth degree perineal trauma, episiotomy and oxytocin during the third stage of labour.

<p>Third of fourth degree perineal trauma, episiotomy and oxytocin during the third stage of labour.</p

Comparison of difference in CS rate between planned home birth and planned hospital birth in the Netherlands with the difference in CS rate between planned home and planned birth in an alongside midwifery unit in England.

<p>Comparison of difference in CS rate between planned home birth and planned hospital birth in the Netherlands with the difference in CS rate between planned home and planned birth in an alongside midwifery unit in England.</p

Clinical signs when sepsis was diagnosed in the sepsis-related maternal deaths in Suriname between 2010 and 2014 (n = 27).

<p>Clinical signs when sepsis was diagnosed in the sepsis-related maternal deaths in Suriname between 2010 and 2014 (n = 27).</p