Offerhaus Pien M, de Jonge Ank, van der Pal-de Bruin Karin M, Hukkelhoven Chantal W P M, Scheepers Peer L H, Lagro-Janssen Antoine L M
KNOV (Royal Dutch Organisation for Midwives), P.O. Box 2001, 3500 GA Utrecht, The Netherlands.
Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
Midwifery. 2014 May;30(5):560-6. doi: 10.1016/j.midw.2013.06.013. Epub 2013 Jul 25.
to study whether an increase in intrapartum referrals in primary midwife-led care births in the Netherlands is accompanied by an increase in caesarean sections.
nationwide descriptive study.
the Netherlands Perinatal Registry.
789,795 births of nine year cohorts of women with low risk pregnancies in primary midwife-led care at the onset of labour between 2000 and 2008.
primary outcome is the caesarean section rate. Vaginal instrumental delivery, augmentation with oxytocin, and pharmacological pain relief are secondary outcomes. Trends in outcomes are described. We used logistic regression to explore whether changes in the planned place of birth and other maternal characteristics influenced the caesarean section rate.
the caesarean section rate did not increase and was 5.5 per cent (range 4.9-6.3 per cent) for nulliparous women, and 1.0 per cent (range 0.8-1.1 per cent) for multiparous women. After controlling for the decline in planned home births and other maternal characteristics no increase in the caesarean section rate was found. The vaginal instrumental birth rate showed no increase, and was 18.1 per cent (range 17.9-18.5 per cent) for nulliparous women and 1.5 per cent (range 1.4-1.7 per cent) for multiparous women. Augmentation of labour and/or pharmacological pain relief increased from 24.0 to 38.8 per cent for nulliparous women, and from 5.4 to 10.0 per cent for multiparous women.
the rise in intrapartum referrals was not accompanied by an increase in caesarean section rate over the period 2000-2008. Despite a considerable rise in the use of pain relief and augmentation, the rate of spontaneous vaginal birth remained high for low risk women who started labour in primary midwife-led care.
the current strict role division between primary care midwives and the obstetrician-led team increasingly results in a change in care provider during labour. In a more integrated care system, more women can receive continuous support of labour from their own primary care midwife, as long as only supportive interventions are needed.
研究荷兰由初级助产士主导护理的分娩中，产时转诊增加是否伴随着剖宫产率的上升。
全国性描述性研究。
荷兰围产期登记处。
2000年至2008年期间，在分娩开始时由初级助产士主导护理的、低风险妊娠的9个年份队列中的789,795例分娩。
主要结局是剖宫产率。阴道器械助产、缩宫素引产及药物镇痛是次要结局。描述结局的趋势。我们使用逻辑回归来探究计划分娩地点的变化及其他产妇特征是否会影响剖宫产率。
剖宫产率未上升，初产妇的剖宫产率为5.5%（范围4.9 - 6.3%），经产妇为1.0%（范围0.8 - 1.1%）。在控制了计划在家分娩的减少及其他产妇特征后，未发现剖宫产率上升。阴道器械助产率未增加，初产妇为18.1%（范围17.9 - 18.5%），经产妇为1.5%（范围1.4 - 1.7%）。初产妇引产和/或药物镇痛从24.0%增至38.8%，经产妇从5.4%增至10.0%。
2000年至2008年期间，产时转诊增加并未伴随着剖宫产率上升。尽管镇痛和引产的使用大幅增加，但在初级助产士主导护理下开始分娩的低风险女性自然阴道分娩率仍然很高。
目前初级保健助产士与产科医生主导团队之间严格的角色划分，越来越导致分娩期间护理提供者的改变。在更综合的护理系统中，只要仅需要支持性干预，更多女性可以从自己的初级保健助产士那里获得持续的分娩支持。
