de Jonge Ank, Peters Lilian, Geerts Caroline C, van Roosmalen Jos J M, Twisk Jos W R, Brocklehurst Peter, Hollowell Jennifer
Department of Midwifery Science, AVAG and Amsterdam Public Health research institute, VU University Medical Center at Amsterdam, Amsterdam, the Netherlands.
Athena Institute, VU University, Amsterdam, the Netherlands.
PLoS One. 2017 Jul 27;12(7):e0180846. doi: 10.1371/journal.pone.0180846. eCollection 2017.
To compare mode of birth and medical interventions between broadly equivalent birth settings in England and the Netherlands.
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).
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). 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.
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.
比较英格兰和荷兰大致相当的分娩环境下的分娩方式和医疗干预措施。
数据来自英格兰的出生地研究（2008年4月至2010年4月）和荷兰的国家围产期登记册（2009年）。将英格兰计划在家分娩（16470例）或在独立助产机构分娩（11133例）的低风险女性与计划在家分娩的荷兰女性（40468例）进行比较。将英格兰计划在附属助产机构（16418例）或产科病房（19096例）分娩的低风险女性与计划由助产士主导在医院分娩的荷兰女性（37887例）进行比较。
初产妇计划分娩环境下的剖宫产率在6.5%至15.5%之间，经产妇在0.6%至5.1%之间。与计划由助产士主导在医院分娩的荷兰女性相比，计划在产科病房分娩的低风险初产妇和经产妇的剖宫产率更高（校正后（adj）比值比分别为1.89（95%置信区间1.64至2.18）和3.66（2.90至4.63））。初产妇器械助产率在10.7%至22.5%之间，经产妇在0.9%至5.7%之间。除了计划在产科病房分娩外，英格兰比较组的器械助产率较低。对于所有由助产士主导的组，英格兰的转诊、引产和会阴切开率远低于荷兰。在大多数比较中，英格兰组的硬膜外麻醉率更高。
在考虑产妇结局时，研究结果证实了低风险女性在由助产士主导的环境中分娩的优势。需要进一步研究降低英格兰产科病房医疗干预率以及降低荷兰可避免的转诊、会阴切开和引产率的策略。
