Differences in rates of severe perineal trauma between midwife-led and obstetrician-led care in the Netherlands: A nationwide cohort study
Anna E. Seijmonsbergen-Schermers,
Kelly MCM. Peerdeman,
Thomas van den Akker,
Linde ML. Titulaer,
Jan-Paul Roovers,
Lilian L. Peters,
Corine J. Verhoeven,
Ank de Jonge
Affiliations
Anna E. Seijmonsbergen-Schermers
Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, Netherlands; Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, PO Box 196, 9700, AD, Groningen, Netherlands; Corresponding author. Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, Netherlands.
Kelly MCM. Peerdeman
Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, Netherlands; Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, PO Box 196, 9700, AD, Groningen, Netherlands
Thomas van den Akker
Department of Obstetrics and Gynaecology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, Netherlands; Athena Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081, HV, Amsterdam, Netherlands
Linde ML. Titulaer
Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, Netherlands; Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, PO Box 196, 9700, AD, Groningen, Netherlands
Jan-Paul Roovers
Department of Obstetrics and Gynaecology, Amsterdam UMC Location AMC, Amsterdam, Netherlands
Lilian L. Peters
Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, Netherlands; Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, PO Box 196, 9700, AD, Groningen, Netherlands
Corine J. Verhoeven
Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, Netherlands; Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, PO Box 196, 9700, AD, Groningen, Netherlands; Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, Netherlands; Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom; Amsterdam Reproduction and Development, Amsterdam, Netherlands
Ank de Jonge
Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, Netherlands; Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, PO Box 196, 9700, AD, Groningen, Netherlands; School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
Objective: To investigate trends and rates of severe perineal trauma (SPT), also known as obstetric anal sphincter injury (OASI), between midwife-led and obstetrician-led care in the Netherlands, and factors associated with SPT. Methods: This nationwide cohort study included registry data from 2000 to 2019 (n = 2,169,950) of spontaneous vaginal births of term, live, cephalic, single infants, without a (previous) caesarean section or assisted vaginal birth.First, trends of SPT and episiotomy were shown. Second, differences in SPT rates between midwife- and obstetrician-led care were assessed. Third, associations of care factors with SPT were examined. Multivariable logistic regression analyses were used to determine which factors were important in the associations. All outcomes were stratified for parity. Results: Over time, the SPT incidence increased mainly in midwife-led care and episiotomy rates decreased. Compared to midwife-led care, SPT rates were lower in obstetrician-led care among primiparous women (aOR 0.78; 99 % CI 0.74–0.81) and comparable among multiparous women (aOR 1.04; 99 % CI 0.99–1.10). Among women without epidural analgesia, these differences were smaller for primiparous women (aOR 0.88; 99 % CI 0.84–0.92), but the SPT rate was higher in obstetrician-led care among multiparous women (aOR 1.09; 99 % CI 1.03–1.15). Among women without shoulder dystocia, induction, augmentation, and pain medication, SPT rates were comparable among primiparous women, but higher among multiparous women in obstetrician-led care. In midwife-led care, SPT occurred more often among hospital versus home births. In obstetrician-led care, lower SPT incidences were found among births with epidural analgesia and for multiparous women with induction or augmentation. Conclusions: Iinduction, augmentation, and epidural analgesia in obstetrician-led care may be an explanatory factor for the higher incidence of SPT among primiparous women in midwife-led care. More research is needed to explain differences in SPT rates and to understand how SPT can be prevented, while maintaining a high intact perineum rate.
