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Organization of Care: Place of Birth, Risk Selection and Integration of Care

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Women's Health".

Deadline for manuscript submissions: closed (31 October 2022) | Viewed by 37008

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Special Issue Editors

Prof. Dr. Ank de Jonge

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Guest Editor

Department of Midwifery Science AVAG, Amsterdam UMC, University of Amsterdam, 1081 HV Amsterdam, Netherlands
Interests: organization of care; place of birth; intrauterine growth restriction; birthing positions; continuity of carer

Dr. Jens Henrichs

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Guest Editor

Department of Midwifery Science AVAG, Amsterdam UMC, University of Amsterdam, 1081 HV Amsterdam, Netherlands
Interests: fetal growth restriction; birth and child outcomes; prenatal risk factors

Dr. Lilian Peters

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Guest Editor

Department of Midwifery Science AVAG, Amsterdam UMC, University of Amsterdam, 1081 HV Amsterdam, Netherlands; University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, Netherlands
Interests: women’s health; big data; labour interventions; women in vulnerable situations; lifestyle interventions

Prof. Dr. Corine Verhoeven

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Guest Editor

Department of Midwifery Science AVAG, Amsterdam UMC, University of Amsterdam, 1081 HV Amsterdam, Netherlands; Division of Midwifery, School of Health Science, University of Nottingham, Nottingham, NG7 2HA, UK
Interests: evaluation of maternity and/or midwifery care; optimizing physiological labour and birth; childbirth experience

Special Issue Information

Dear Colleagues,

The organization of maternal and newborn care differs between countries and regions. It is important to identify aspects of the organization of care that enhance good quality and evidence-based care that optimizes women’s experience of pregnancy and birth. Adequate risk selection is an important element of a maternity care organization. It supports the identification of women and babies that need medical interventions and specialist care in addition to general preventive and supportive care. Adequate risk selection is based on a balance between promoting health and managing risk. It ensures that women and babies receive appropriate care, not too much and not too little, at the right place and the right time. Risk selection is also important for advising women about their choices in care, for example regarding the place of birth.

The process of risk selection is complex and is influenced by contextual factors such as geography, government policy, laws and regulation, health financing, history, and culture. Additionally, the way risk selection is organized my effect subgroups of women differently. For example, social class and ethnicity may interact with each other and with medical risks in various ways.

For this special issue, we invite authors to submit papers on the complex interplay of factors that are related to the organization and process of risk selection and how these affect different groups of women. In particular, we welcome contributions on the balance between too much and too little medical care, the role of women (representatives) in policy and practice of risk selection, the framing of risk versus health, and economic evaluations of risk selection.

Prof. Dr. Ank de Jonge
Dr. Jens Henrichs
Dr. Lilian Peters
Prof. Dr. Corine Verhoeven
Guest Editors

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Keywords

risk selection
place of birth
integration of care
medicalization
maternal and newborn care
maternity care

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Published Papers (8 papers)

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Research

16 pages, 1325 KiB

Open AccessArticle

Cost-Effectiveness of Routine Third Trimester Ultrasound Screening for Fetal Growth Restriction Compared to Care as Usual in Low-Risk Pregnancies: A Pragmatic Nationwide Stepped-Wedge Cluster-Randomized Trial in The Netherlands (the IRIS Study)

by Jens Henrichs, Ank de Jonge, Myrte Westerneng, Viki Verfaille, Arie Franx, Henriëtte E. van der Horst, Judith E. Bosmans and on behalf of the IRIS Study Group

Int. J. Environ. Res. Public Health 2022, 19(6), 3312; https://doi.org/10.3390/ijerph19063312 - 11 Mar 2022

Cited by 7 | Viewed by 3021

Abstract

Routine third trimester ultrasonography is increasingly used to screen for fetal growth restriction. However, evidence regarding its cost-effectiveness is lacking. We aimed to evaluate the cost-effectiveness of routine third trimester ultrasonography to reduce adverse perinatal outcomes compared to usual care (selective ultrasonography). An economic evaluation alongside a stepped-wedge cluster-randomized trial was conducted. Via 60 midwifery practices 12,974 Dutch women aged ≥16 years with low-risk pregnancies were enrolled at 22.8 (SD = 2.4) weeks’ gestation. All practices provided usual care. At 3, 7, and 10 months a third of the practices were randomized to the intervention strategy providing routine ultrasonography at 28–30 and 34–36 weeks’ gestation and usual care. The primary clinical outcome was a dichotomous composite measure of 12 severe adverse perinatal outcomes (SAPO) up to one week postpartum. Information on perinatal care and societal costs was derived from Netherlands Perinatal Registry, hospital records and a survey. Cost-effectiveness analyses revealed no significant differences in SAPO and healthcare and societal costs between the intervention strategy (n = 7026) and usual care (n = 5948). Cost-effectiveness acceptability curves showed that the probability of cost-effectiveness was never higher than 0.6 for all possible ceiling ratios. Adding routine third trimester ultrasonography to usual care is not cost-effective in reducing SAPO. Full article

(This article belongs to the Special Issue Organization of Care: Place of Birth, Risk Selection and Integration of Care)

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15 pages, 597 KiB

Open AccessArticle

Models of Risk Selection in Maternal and Newborn Care: Exploring the Organization of Tasks and Responsibilities of Primary Care Midwives and Obstetricians in Risk Selection across The Netherlands

by Bahareh Goodarzi, Corine Verhoeven, Durk Berks, Eline F. de Vries and Ank de Jonge

Int. J. Environ. Res. Public Health 2022, 19(3), 1046; https://doi.org/10.3390/ijerph19031046 - 18 Jan 2022

Cited by 1 | Viewed by 2543

Abstract

An effective system of risk selection is a global necessity to ensure women and children receive appropriate care at the right time and at the right place. To gain more insight into the existing models of risk selection (MRS), we explored the distribution of different MRS across regions in The Netherlands, and examined the relation between MRS and primary care midwives’ and obstetricians’ satisfaction with different MRS. We conducted a nationwide survey amongst all primary midwifery care practices and obstetrics departments. The questionnaire was completed by 312 (55%) primary midwifery care practices and 53 (72%) obstetrics departments. We identified three MRS, which were distributed differently across regions: (1) primary care midwives assess risk and initiate a consultation or transfer of care without discussing this first with the obstetrician, (2) primary care midwives assess risk and make decisions about consultation or transfer of care collaboratively with obstetricians, and (3) models with other characteristics. Across these MRS, variations exist in several aspects, including the routine involvement of the obstetrician in the care of healthy pregnant women. We found no significant difference between MRS and professionals’ level of satisfaction. An evidence- and value-based approach is recommended in the pursuit of the optimal organization of risk selection. This requires further research into associations between MRS and maternal and perinatal outcomes, professional payment methods, resource allocation, and the experiences of women and care professionals. Full article

(This article belongs to the Special Issue Organization of Care: Place of Birth, Risk Selection and Integration of Care)

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16 pages, 359 KiB

Open AccessArticle

How to Make the Hospital an Option Again: Midwives’ and Obstetricians’ Experiences with a Designated Clinic for Women Who Request Different Care than Recommended in the Guidelines

by Floor Opdam, Jeroen van Dillen, Marieke de Vries and Martine Hollander

Int. J. Environ. Res. Public Health 2021, 18(21), 11627; https://doi.org/10.3390/ijerph182111627 - 5 Nov 2021

Cited by 6 | Viewed by 2692

Abstract

Background: An increasing number of maternity care providers encounter pregnant women who request less care than recommended. A designated outpatient clinic for women who request less care than recommended was set up in Nijmegen, the Netherlands. The clinic’s aim is to ensure that women make well-informed choices and arrive at a care plan that is acceptable to all parties. The aim of this study is to make the clinic’s approach explicit by examining care providers’ experiences who work with or within the clinic. Methods: qualitative analysis of in-depth interviews with Dutch midwives (n = 6) and obstetricians (n = 4) on their experiences with the outpatient clinic “Maternity Care Outside the Guidelines” in Nijmegen, the Netherlands. Results: Four main themes were identified: (1) ”Trusting mothers, childbirth and colleagues”; (2) “A supportive communication style”; (3) “Continuity of carer”; (4) “Willingness to reconsider responsibility and risk”. One overarching theme emerged from the data, which was “Guaranteeing women’s autonomy”. Mutual trust is a prerequisite for a constructive dialogue about birth plans and can be built and maintained more easily when there is continuity of carer during pregnancy and birth. Discussing birth plans at the clinic was believed to be successful because the care providers listen to women, take them seriously, show empathy and respect their right to refuse care. A change in vision on responsibility and risk is needed to overcome barriers such as providers’ fear of adverse outcomes. Taking a more flexible approach towards care outside the guidelines demands courage but is necessary to guarantee women’s autonomy. Key conclusions and implications for practice: In order to fulfil women’s needs and to prevent negative choices, care providers should care for women with trust, respect for autonomy, and provide freedom of choice and continuity. Care providers should reflect on and discuss why they are reluctant to support women’s wishes that go against their personal values. The structured approach used at this clinic could be helpful to maternity care providers in other contexts, to make them feel less vulnerable when working outside the guidelines. Full article

(This article belongs to the Special Issue Organization of Care: Place of Birth, Risk Selection and Integration of Care)

13 pages, 895 KiB

Open AccessArticle

Investigating Caesarean Section Practice among Teenage Romanian Mothers Using Modified Robson Ten Group Classification System

by Alexandra Matei, Mihai Cornel Dimitriu, George Alexandru Roșu, Cristian George Furău and Crîngu Antoniu Ionescu

Int. J. Environ. Res. Public Health 2021, 18(20), 10727; https://doi.org/10.3390/ijerph182010727 - 13 Oct 2021

Cited by 3 | Viewed by 1957

Abstract

The Robson ten-group classification system is a recognized effective method of assessing caesarean rate. It is based on dividing patients into ten mutually exclusive groups, focusing on six maternal and newborn variables (parity, gestational age, plurality, foetal presentation, previous caesarean, and mode of labour onset). The aim of our analysis was twofold: first, to present the implementation of Robson classification in a pregnant teenage population; and second, to identify the indications for CS in the adolescent population. This study was designed as a one-year prospective analysis and considered all women younger than 20 years of age who delivered in a tertiary care hospital. Before discharge, women who had caesarean delivery responded to a questionnaire regarding their education, prenatal surveillance, and obstetrical history. Caesarean sections accounted for 47.01% of all births. A proportion of 24.57% of the participants had at least one previous caesarean section. Group 10 (all women with a single cephalic preterm pregnancy) was second most often identified among women in middle adolescence (14.03%); 32.20% of the participants in late adolescence were in group 5 (multiparas with a scarred uterus, single cephalic term pregnancy). Differences between the two age groups were not statistically different (p = 0.96). Abnormal cardiotocographic findings (38.23%), the arrest of descent (19.11%) and arrest of dilation (19.11%), were the most frequent indications for caesareans in Robson group 1. Neonates from mothers in Robson groups 8 (women with a multiple pregnancy) and 7 (multiparas single breech pregnancy) had the most unfavourable outcomes regarding gestational age at delivery and admission to the intensive care unit. We concluded that future focus on obstetrical management is mandatory in Robson groups 7 and 8. Adolescents in Robson group 1 (nulliparas, single cephalic term pregnancy, spontaneous labour) are the primary beneficiaries of strategies to reduce caesarean sections rates. Full article

(This article belongs to the Special Issue Organization of Care: Place of Birth, Risk Selection and Integration of Care)

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8 pages, 420 KiB

Open AccessArticle

The Cost of Home Birth in the United States

by David A. Anderson and Gabrielle M. Gilkison

Int. J. Environ. Res. Public Health 2021, 18(19), 10361; https://doi.org/10.3390/ijerph181910361 - 1 Oct 2021

Cited by 5 | Viewed by 12904

Abstract

Policy decisions about the accessibility of home birth hinge on questions of safety and affordability. Families consider safety and cost along with the comfort and familiarity of birthing venues. A substantial literature addresses safety concerns, generally reporting that for low-risk mothers in the care of credentialed midwives, the safety of planned home births is comparable to that in birth centers and hospitals. The lack of notable safety tradeoffs for low-risk mothers elevates the relevance of the economic efficiency of home births. The available cost figures for home births are largely out of date or anecdotal. The purpose of this research is to offer scholars, policymakers, and families improved estimates of both the cost of home births and the potential savings from greater access to home births. On the basis of a nationwide study, we estimate that the average cost of a home birth in the United States is USD 4650, which is significantly below existing cost estimates for an uncomplicated birth center or hospital birth. Further, we find that each shift of one percent of births from hospitals to homes would represent an annual cost savings to society of at least USD 321 million. Full article

(This article belongs to the Special Issue Organization of Care: Place of Birth, Risk Selection and Integration of Care)

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11 pages, 9527 KiB

Open AccessArticle

Effects of a Personal Health Record in Maternity Care: A Stepped-Wedge Trial

by Carola J. M. Groenen, Jan A. M. Kremer, Joanna IntHout, Marjan J. Meinders, Noortje T. L. van Duijnhoven and Frank P. H. A. Vandenbussche

Int. J. Environ. Res. Public Health 2021, 18(19), 10343; https://doi.org/10.3390/ijerph181910343 - 30 Sep 2021

Cited by 2 | Viewed by 2057

Abstract

To improve both the active involvement of pregnant women in their maternal health and multidisciplinary collaboration between maternal care professionals, we introduced a personal health record (PHR) in routine maternity care. We studied the effects of this intervention on the percentage of uncomplicated births, women’s perspectives on quality of care, and the collaboration between health care professionals. We performed a stepped-wedge cluster randomized controlled trial with four clusters and 13 maternity health centers (community-based midwife practices and hospitals) in one collaborative area. In total, 7350 pregnant women and 220 health care professionals participated. Uncomplicated births accounted for 51.8% (95% CI 50.1–53.9%) of total births in the control group and 55.0% (CI 53.5–56.5%) of total births in the intervention group (p = 0.289). Estimated means revealed that the differences detected in the stepped-wedge study were due to time and not the intervention. Women’s perspectives on quality of care and collaboration between health care professionals revealed no relevant differences between the control and intervention groups. The introduction of the PHR resulted in no significant effect on the chosen measures of quality of maternal care. The suggested positive effect in the raw data was a local trend which was less visible in the national database, and thus might be related to subtle changes toward an improved collaborative culture in the study region. Full article

(This article belongs to the Special Issue Organization of Care: Place of Birth, Risk Selection and Integration of Care)

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16 pages, 1545 KiB

Open AccessArticle

Effects of a Midwife-Coordinated Maternity Care Intervention (ChroPreg) vs. Standard Care in Pregnant Women with Chronic Medical Conditions: Results from a Randomized Controlled Trial

by Mie G. de Wolff, Julie Midtgaard, Marianne Johansen, Ane L. Rom, Susanne Rosthøj, Ann Tabor and Hanne K. Hegaard

Int. J. Environ. Res. Public Health 2021, 18(15), 7875; https://doi.org/10.3390/ijerph18157875 - 25 Jul 2021

Cited by 8 | Viewed by 5498

Abstract

The proportion of childbearing women with pre-existing chronic medical conditions (CMC) is rising. In a randomized controlled trial, we aimed to evaluate the effects of a midwife-coordinated maternity care intervention (ChroPreg) in pregnant women with CMC. The intervention consisted of three main components: (1) Midwife-coordinated and individualized care, (2) Additional ante-and postpartum consultations, and (3) Specialized known midwives. The primary outcome was the total length of hospital stay (LOS). Secondary outcomes were patient-reported outcomes measuring psychological well-being and satisfaction with maternity care, health utilization, and maternal and infant outcomes. A total of 362 women were randomized to the ChroPreg intervention (n = 131) or Standard Care (n = 131). No differences in LOS were found between groups (median 3.0 days, ChroPreg group 0.1% lower LOS, 95% CI −7.8 to 7%, p = 0.97). Women in the ChroPreg group reported being more satisfied with maternity care measured by the Pregnancy and Childbirth Questionnaire (PCQ) compared with the Standard Care group (mean PCQ 104.5 vs. 98.2, mean difference 6.3, 95% CI 3.0–10.0, p < 0.0001). In conclusion, the ChroPreg intervention did not reduce LOS. However, women in the ChroPreg group were more satisfied with maternity care. Full article

(This article belongs to the Special Issue Organization of Care: Place of Birth, Risk Selection and Integration of Care)

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16 pages, 679 KiB

Open AccessArticle

Women’s Participation in Decision-Making in Maternity Care: A Qualitative Exploration of Clients’ Health Literacy Skills and Needs for Support

by Laxsini Murugesu, Olga C. Damman, Marloes E. Derksen, Danielle R. M. Timmermans, Ank de Jonge, Ellen M. A. Smets and Mirjam P. Fransen

Int. J. Environ. Res. Public Health 2021, 18(3), 1130; https://doi.org/10.3390/ijerph18031130 - 27 Jan 2021

Cited by 21 | Viewed by 4575

Abstract

Shared decision-making requires adequate functional health literacy (HL) skills from clients to understand information, as well as interactive and critical HL skills to obtain, appraise and apply information about available options. This study aimed to explore women’s HL skills and needs for support regarding shared decision-making in maternity care. In-depth interviews were held among women in Dutch maternity care who scored low (n = 10) and high (n = 13) on basic health literacy screening test(s). HL skills and perceived needs for support were identified through thematic analysis. Women appeared to be highly engaged in the decision-making process. They mentioned searching and selecting general information about pregnancy and labor, constructing their preferences based on their own pre-existing knowledge and experiences and by discussions with partners and significant others. However, women with low basic skills and primigravida perceived difficulties in finding reliable information, understanding probabilistic information, constructing preferences based on benefit/harm information and preparing for consultations. Women also emphasized dealing with uncertainties, changing circumstances of pregnancy and labor, and emotions. Maternity care professionals could further support clients by guiding them towards reliable information. To facilitate participation in decision-making, preparing women for consultations (e.g., agenda setting) and supporting them in a timely manner to understand benefit/harm information seem important. Full article

(This article belongs to the Special Issue Organization of Care: Place of Birth, Risk Selection and Integration of Care)

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