Intrapartum Quality of Care among Healthy Women: A Population-Based Cohort Study in an Italian Region
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Source
2.2. Setting
2.3. Participants
2.4. Variables
2.5. Statistical Methods
3. Results
3.1. Sample’s Characteristics
3.2. Impact of Hospital’s Birth Volume Categories on Intrapartum Midwifery Care
3.3. Impact of Hospital’s Birth Volume Categories on Maternal and Neonatal Outcomes
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Overall | LV Hospitals | HV Hospitals | p-Value | ||||
---|---|---|---|---|---|---|---|
n | n | % | n | % | |||
Number of healthy pregnancies | 145,224 | 41,950 | 28.89 | 103,274 | 71.11 | ||
mean | SD | mean | SD | mean | SD | ||
Age | 32.14 | 5.09 | 31.34 | 5.29 | 32.44 | 4.97 | |
n | % | n | % | n | % | ||
16–25 | 15,732 | 10.83 | 6131 | 14.62 | 9601 | 9.30 | <0.0001 |
26–35 | 90,613 | 62.40 | 26,140 | 62.31 | 64,473 | 62.43 | |
36–45 | 38,371 | 26.42 | 9421 | 22.46 | 28950 | 28.03 | |
Birth place | n | % | n | % | n | % | |
Italian born | 97,239 | 66.96 | 25,189 | 60.05 | 72,050 | 69.77 | <0.0001 |
Foreign born | 47,985 | 33.04 | 16,761 | 39.95 | 31,224 | 30.23 | |
Education | n | % | n | % | n | % | |
Primary education | 28,919 | 19.91 | 11,908 | 28.39 | 17,011 | 16.47 | <0.0001 |
High school | 60,618 | 41.74 | 19,200 | 45.77 | 41,418 | 40.10 | 0.250 |
Bachelor | 7589 | 5.23 | 2064 | 4.92 | 5525 | 5.35 | 0.004 |
Master | 48,034 | 33.08 | 8763 | 20.89 | 39,271 | 38.03 | <0.0001 |
Missing | 64 | 0.04 | 15 | 0.04 | 49 | 0.05 | 0.147 |
Occupation | n | % | n | % | n | % | |
Employed | 96,861 | 66.70 | 23,427 | 55.85 | 73,434 | 71.11 | <0.0001 |
Housewife | 33,010 | 22.73 | 14,127 | 33.68 | 18,883 | 18.28 | <0.0001 |
Student | 1208 | 0.83 | 341 | 0.81 | 867 | 0.84 | <0.0001 |
Looking for first employment | 147 | 0.10 | 51 | 0.12 | 96 | 0.09 | 0.102 |
Unemployed | 13,748 | 9.47 | 3929 | 9.37 | 9819 | 9.51 | 0.653 |
Others | 155 | 0.11 | 63 | 0.15 | 92 | 0.09 | 0.001 |
Missing | 95 | 0.07 | 12 | 0.03 | 83 | 0.08 | <0.0001 |
Parity | |||||||
Primiparous | 55,114 | 37.95 | 14,271 | 34.02 | 40,843 | 39.55 | <0.0001 |
Best Practices | Overall (n = 145,224) | LV Hospitals | HV Hospitals | aOR + | 95% CI ++ | p-Value | |||
---|---|---|---|---|---|---|---|---|---|
n | % | n | % | n | % | ||||
Nonpharmacological coping strategies | 109,601 | 75.47 | 33,955 | 80.94 | 75,646 | 73.25 | 0.802 | [0.775; 0.83] | <0.0001 |
Presence of birth companion | 122,618 | 84.43 | 33,326 | 79.44 | 89,292 | 86.46 | 1.530 | [1.481; 1.581] | <0.0001 |
Skin to skin * | 102,728 | 70.74 | 26,971 | 64.29 | 75,757 | 73.36 | 1.393 | [1.357; 1.429] | <0.0001 |
First breastfeeding within 1 h | 113,224 | 77.97 | 31,537 | 75.18 | 81,687 | 79.10 | 1.218 | [1.183; 1.254] | <0.0001 |
Intrapartum interventions | |||||||||
Augmentation with amniotomy | 4100 | 2.82 | 939 | 2.24 | 3161 | 3.06 | 0.995 | [0.705; 1.406] | 0.963 |
Epidural analgesia | 37,016 | 25.49 | 5917 | 14.10 | 31,099 | 30.11 | 2.263 | [2.197; 2.330] | <0.0001 |
Nonepidural analgesia | 7257 | 5.00 | 3229 | 7.70 | 4298 | 4.16 | 0.573 | [0.544; 0.605] | <0.0001 |
Episiotomy * | 23,411 | 16.12 | 6406 | 15.27 | 17,005 | 16.47 | 1.077 | [1.044; 1.110] | <0.0001 |
Healthcare providers present at birth | |||||||||
Midwife | 143,485 | 98.80 | 41,393 | 98.67 | 102,092 | 98.86 | 0.956 | [0.861; 1061] | 0.397 |
Gynecologist ** | 104,174 | 71.73 | 36,130 | 86.13 | 68,044 | 65.89 | 0.34 | [0.33; 0.349] | <0.0001 |
Pediatrician ** | 63,231 | 43.54 | 23,939 | 57.07 | 39,292 | 38.05 | 0.446 | [0.435; 0.457] | <0.0001 |
Maternal and Neonatal Outcomes | Overall (n = 145,224) | LV Hospitals | HV Hospitals | aOR + | 95% IC ++ | p-Value | |||
---|---|---|---|---|---|---|---|---|---|
Spontaneous vaginal birth | 126,747 | 87.30 | 36,357 | 86.67 | 90,390 | 87.52 | 0.771 | [0.572; 1.039] | 0.081 |
Vacuum-assisted birth | 7268 | 5.10 | 1885 | 4.49 | 5383 | 5.21 | 0.724 | [0.535; 0.981] | 0.042 |
Caesarean section | 11,025 | 7.60 | 3680 | 8.77 | 7345 | 7.11 | 0.754 | [0.558; 1.019] | 0.068 |
Perineal integrity * | 62,214 | 42.84 | 18,914 | 45.09 | 43,300 | 41.93 | 0.89 | [0.869; 0.912] | <0.0001 |
Blood loss <1000 mL | 140,188 | 96.53 | 40,582 | 96.74 | 99,606 | 96.45 | 0.911 | [0.856; 0.97] | 0.003 |
Low Apgar score at 5 min (<7) | 597 | 0.41 | 189 | 0.45 | 408 | 0.40 | 0.872 | [0.736; 1.033] | 0.113 |
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Fumagalli, S.; Nespoli, A.; Panzeri, M.; Pellegrini, E.; Ercolanoni, M.; Vrabie, P.S.; Leoni, O.; Locatelli, A. Intrapartum Quality of Care among Healthy Women: A Population-Based Cohort Study in an Italian Region. Int. J. Environ. Res. Public Health 2024, 21, 629. https://doi.org/10.3390/ijerph21050629
Fumagalli S, Nespoli A, Panzeri M, Pellegrini E, Ercolanoni M, Vrabie PS, Leoni O, Locatelli A. Intrapartum Quality of Care among Healthy Women: A Population-Based Cohort Study in an Italian Region. International Journal of Environmental Research and Public Health. 2024; 21(5):629. https://doi.org/10.3390/ijerph21050629
Chicago/Turabian StyleFumagalli, Simona, Antonella Nespoli, Maria Panzeri, Edda Pellegrini, Michele Ercolanoni, Paul Stefan Vrabie, Olivia Leoni, and Anna Locatelli. 2024. "Intrapartum Quality of Care among Healthy Women: A Population-Based Cohort Study in an Italian Region" International Journal of Environmental Research and Public Health 21, no. 5: 629. https://doi.org/10.3390/ijerph21050629