A Meta-Analysis of Thyroid-Related Traits Reveals Novel Loci and Gender-Specific Differences in the Regulation of Thyroid Function

Peer reviewe

Comparison of Induction of Labour and Expectant Management in Postterm Pregnancy: A Matched Cohort Study

Randomized clinical trials have shown that induction of tabour does not result in higher caesarean delivery rates in women who are postterm. Despite this evidence, the policy of inducing women who are postterm is not generally applied in the Netherlands. This provides us with the opportunity to assess whether the findings from randomized studies can also be observed in nonrandomized studies and to validate these findings in the Dutch obstetric population. We performed a retrospective matched cohort study (1: 1 ratios for both age and parity) in women with uncomplicated pregnancies of 42 weeks' duration and compared induction of labour with a policy of serial antenatal monitoring. Analyses were made by the intention to treat principle. We studied 674 women. Among the 337 women in the expectant management group, 42 (12.5%) underwent caesarean delivery, compared to 46 (13.6%) of the 337 women in the induction group (relative risk [RR], 0.9; 95% confidence interval [CI], 0.6-1.4). However, the incidence of shoulder dystocia (RR, 4.3; 95% CI, 1.3-15) and meconium-stained amniotic fluid (RR, 1.8; 95% CI, 1.4-2.3) were higher in the expectant management group. Induction of labour does not result in an increased risk of caesarean delivery in women who are postterm. Because epidemiologic studies suggest an increased risk of perinatal death and birth injury beyond 42 weeks' gestation, induction of labour should be offered to all women who are postterm. J Midwifery Womens Health 2009;54:351-356 (C) 2009 by the American College of Nurse-Midwive

Job satisfaction of maternity care providers in the Netherlands: Does working in or with a birth centre influence job satisfaction?

Introduction In the Netherlands birth centres have recently become an alternative option as places where women with uncomplicated pregnancies can give birth. This article focusses on the job satisfaction of three groups of maternity care providers (community midwives, clinical care providers and maternity care assistants) working in or with a birth centre compared to those working only in a hospital or at home. Methods In 2015, an existing questionnaire was adapted and distributed to maternity care providers and 4073 responses were received. Using factor analyses, two composite measures were constructed, a Composite Job Satisfaction scale and an Assessment-of- Working-in-or-with-a-Birth-Centre scale. Differences between groups were tested with Student’s t-test and MANOVA with post hoc test and linear regression analyses. Results The overall score on the Composite Job Satisfaction scale did not differ between community midwives or clinical care providers working in or with a birth centre and those working in a different setting. For maternity care assistants there was a small but significantly higher score for those not working in a birth centre. Maternity care assistants’ overall job satisfaction score was higher than that of both other groups. In a linear regression analysis working or not working in or with a birth centre was related to the overall job satisfaction score, but repeated for the three professional groups separately, this relation was only found for maternity care assistants. Conclusions Job satisfaction is generally high, but, except for maternity care assistants, not related to the setting (working or not working in or with a birth centre)

An approach to measuring Integrated Care within a Maternity Care System : Experiences from the Maternity Care Network Study and the Dutch Birth Centre Study

Introduction: Integrated care is considered to be a means to reduce costs, improve the quality of care and generate better patient outcomes. At present, little is known about integrated care in maternity care systems. We developed questionnaires to examine integrated care in two different settings, using the taxonomy of the Rainbow Model of Integrated Care. The aim of this study was to explore the validity of these questionnaires. Methods: We used data collected between 2013 and 2015 from two studies: the Maternity Care Network Study (634 respondents) and the Dutch Birth Centre Study (56 respondents). We assessed the feasibility, discriminative validity, and reliability of the questionnaires. Results: Both questionnaires showed good feasibility (overall missing rate 0.70). Between-subgroups post-hoc comparisons showed statistically significant differences on integration profiles between regional networks (on all items, dimensions of integration and total integration score) and birth centres (on 50% of the items and dimensions of integration). Discussion: Both questionnaires are feasible and can discriminate between sites with different integration profiles in The Netherlands. They offer an opportunity to better understand integrated care as one step in understanding the complexity of the concept

An approach to measuring Integrated Care within a Maternity Care System: Experiences from the Maternity Care Network Study and the Dutch Birth Centre Study

textabstractIntroduction: Integrated care is considered to be a means to reduce costs, improve the quality of care and generate better patient outcomes. At present, little is known about integrated care in maternity care systems. We developed questionnaires to examine integrated care in two different settings, using the taxonomy of the Rainbow Model of Integrated Care. The aim of this study was to explore the validity of these questionnaires. Methods: We used data collected between 2013 and 2015 from two studies: the Maternity Care Network Study (634 respondents) and the Dutch Birth Centre Study (56 respondents). We assessed the feasibility, discriminative validity, and reliability of the questionnaires. Results: Both questionnaires showed good feasibility (overall missing rate 0.70). Between-subgroups post-hoc comparisons showed statistically significant differences on integration profiles between regional networks (on all items, dimensions of integration and total integration score) and birth centres (on 50% of the items and dimensions of integration). Discussion: Both questionnaires are feasible and can discriminate between sites with different integration profiles in The Netherlands. They offer an opportunity to better understand integrated care as one step in understanding the complexity of the concept

An approach to assessing the quality of birth centres results of the Dutch birth centre study

Objective: to determine the usability of a recently developed set of 30 structure and process birth centre quality indicators. Design: an explorative study using mixed-methods including literature, a survey, interviews and observations. The study is part of the Dutch Birth Centre Study. We first determined the measurability of birth centre quality indicators by describing them in detail. Next, we assessed the birth centres in the Netherlands according to these indicators using data derived from the Dutch Birth Centre General Questionnaire, the Dutch Birth Centre Integration Questionnaire, interviews, and policy documents. Setting and participants: representatives of 23 birth centres in the Netherlands. Measurements and findings: 28 of the 30 quality indicators could be used to assess birth centres in the Netherlands, one had no optimal value defined, another could not be scored because the information was not available. Each quality indicator could be scored 0 or 1. Differences between birth centres were shown: the scores ranged from 7 to 22. Some of the quality indicators can be combined or made more specific so that they are easier to assess. Some quality indicators need adaptation because they are only applicable for some birth centres (e.g. only for freestanding or alongside birth centres). Key conclusions and implications for practice: 28 of the 30 quality indicators are usable to assess structure and process quality of birth centres. With the findings of this study the set of structure and process quality indicators for birth centres in the Netherlands can be reduced to 22 indicators. This set of quality indicators can contribute to the development of a quality system for birth centres. Further research is necessary to formulate standards or minimum quality requirements for birth centres and to improve the set of birth centre quality indicators.</p

An approach to assessing the quality of birth centres results of the Dutch birth centre study

Objective: to determine the usability of a recently developed set of 30 structure and process birth centre quality indicators. Design: an explorative study using mixed-methods including literature, a survey, interviews and observations. The study is part of the Dutch Birth Centre Study. We first determined the measurability of birth centre quality indicators by describing them in detail. Next, we assessed the birth centres in the Netherlands according to these indicators using data derived from the Dutch Birth Centre General Questionnaire, the Dutch Birth Centre Integration Questionnaire, interviews, and policy documents. Setting and participants: representatives of 23 birth centres in the Netherlands. Measurements and findings: 28 of the 30 quality indicators could be used to assess birth centres in the Netherlands, one had no optimal value defined, another could not be scored because the information was not available. Each quality indicator could be scored 0 or 1. Differences between birth centres were shown: the scores ranged from 7 to 22. Some of the quality indicators can be combined or made more specific so that they are easier to assess. Some quality indicators need adaptation because they are only applicable for some birth centres (e.g. only for freestanding or alongside birth centres). Key conclusions and implications for practice: 28 of the 30 quality indicators are usable to assess structure and process quality of birth centres. With the findings of this study the set of structure and process quality indicators for birth centres in the Netherlands can be reduced to 22 indicators. This set of quality indicators can contribute to the development of a quality system for birth centres. Further research is necessary to formulate standards or minimum quality requirements for birth centres and to improve the set of birth centre quality indicators.</p

Cost-effectiveness of planned birth in a birth centre compared with alternative planned places of birth : Results of the Dutch Birth Centre study

Objectives To estimate the cost-effectiveness of a planned birth in a birth centre compared with alternative planned places of birth for low-risk women. In addition, a distinction has been made between different types of locations and integration profiles of birth centres. Design Economic evaluation based on a prospective cohort study. Setting 21 Dutch birth centres, 46 hospital locations where midwife-led birth was possible and 110 midwifery practices where home birth was possible. Participants 3455 low-risk women under the care of a community midwife at the start of labour in the Netherlands within the study period 1 July 2013 to 31 December 2013. Main outcome measures Costs and health outcomes of birth for different planned places of birth. Healthcare costs were measured from start of labour until 7 days after birth. The health outcomes were assessed by the Optimality Index-NL2015 (OI) and a composite adverse outcomes score. Results The total adjusted mean costs for births planned in a birth centre, in a hospital and at home under the care of a community midwife were €3327, €3330 and €2998, respectively. There was no difference between the score on the OI for women who planned to give birth in a birth centre and that of women who planned to give birth in a hospital. Women who planned to give birth at home had better outcomes on the OI (higher score on the OI). Conclusions We found no differences in costs and health outcomes for low-risk women under the care of a community midwife with a planned birth in a birth centre and in a hospital. For nulliparous and multiparous low-risk women, planned birth at home was the most cost-effective option compared with planned birth in a birth centre

Cost-effectiveness of planned birth in a birth centre compared with alternative planned places of birth : Results of the Dutch Birth Centre study

Objectives To estimate the cost-effectiveness of a planned birth in a birth centre compared with alternative planned places of birth for low-risk women. In addition, a distinction has been made between different types of locations and integration profiles of birth centres. Design Economic evaluation based on a prospective cohort study. Setting 21 Dutch birth centres, 46 hospital locations where midwife-led birth was possible and 110 midwifery practices where home birth was possible. Participants 3455 low-risk women under the care of a community midwife at the start of labour in the Netherlands within the study period 1 July 2013 to 31 December 2013. Main outcome measures Costs and health outcomes of birth for different planned places of birth. Healthcare costs were measured from start of labour until 7 days after birth. The health outcomes were assessed by the Optimality Index-NL2015 (OI) and a composite adverse outcomes score. Results The total adjusted mean costs for births planned in a birth centre, in a hospital and at home under the care of a community midwife were €3327, €3330 and €2998, respectively. There was no difference between the score on the OI for women who planned to give birth in a birth centre and that of women who planned to give birth in a hospital. Women who planned to give birth at home had better outcomes on the OI (higher score on the OI). Conclusions We found no differences in costs and health outcomes for low-risk women under the care of a community midwife with a planned birth in a birth centre and in a hospital. For nulliparous and multiparous low-risk women, planned birth at home was the most cost-effective option compared with planned birth in a birth centre