Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands: a national quasi-experimental study

• Published in: Public health (London) Vol. 235; pp. 15 - 25
• Main Authors: Gravesteijn, B.Y., Boderie, N.W., van den Akker, T., Bertens, L.C.M., Bloemenkamp, K., Burgos Ochoa, L., de Jonge, A., Kazemier, B.M., Klein, P.P.F., Kwint-Reijnders, I., Labrecque, J.A., Mol, B.W., Obermann-Borst, S.A., Peters, L., Ravelli, A.C.J., Rosman, A., Been, J.V., de Groot, C.J., Ambrosino, E., Auweele, K.V., Been, J., Beijers, R., Bertens, L., Boderie, N., Burdorf, L., Ochoa, L.B., de Weerth, C., Franx, A., Harper, S., Klein, P.P., Kretz, D., Labrecque, J., Muris, J., Nieuwenhuijze, M., Obermann, S., Oudijk, M., Ramerman, L., Ravelli, A., Schonewille-Rosman, A., Struijs, J., Torij, H., Van Beukering, M., van den Heuvel, M., van Dillen, J., van Lenthe, F., Van Ourti, T., Verhoeff, A., Vermeulen, M., Visser, N., Willers, S., Schoenmakers, S., Zainularab, Z.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.10.2024
• Subjects: COVID-19; Homebirth; Maternal health; Natural experiment; SARS-CoV−2; COVID-19; Homebirth; SARS-CoV−2; Maternal health; Natural experiment
• ISSN: 0033-3506; 1476-5616; 1476-5616
• DOI: 10.1016/j.puhe.2024.06.024

The COVID-19 pandemic and associated lockdowns disrupted health care worldwide. High-income countries observed a decrease in preterm births during lockdowns, but maternal pregnancy–related outcomes were also likely affected. This study investigates the effect of the first COVID-19 lockdown (March–June 2020) on provision of maternity care and maternal pregnancy–related outcomes in the Netherlands. National quasi-experimental study. Multiple linked national registries were used, and all births from a gestational age of 24+0 weeks in 2010–2020 were included. In births starting in midwife-led primary care, we assessed the effect of lockdown on provision of care. In the general pregnant population, the impact on characteristics of labour and maternal morbidity was assessed. A difference-in-regression-discontinuity design was used to derive causal estimates for the year 2020. A total of 1,039,728 births were included. During the lockdown, births to women who started labour in midwife-led primary care (49%) more often ended at home (27% pre-lockdown, +10% [95% confidence interval: +7%, +13%]). A small decrease was seen in referrals towards obstetrician-led care during labour (46%, −3% [−5%,−0%]). In the overall group, no significant change was seen in induction of labour (27%, +1% [−1%, +3%]). We found no significant changes in the incidence of emergency caesarean section (9%, −1% [−2%, +0%]), obstetric anal sphincter injury (2%, +0% [−0%, +1%]), episiotomy (21%, −0% [−2%, +1%]), or post-partum haemorrhage: >1000 ml (6%, −0% [−1%, +1%]). During the first COVID-19 lockdown in the Netherlands, a substantial increase in homebirths was seen. There was no evidence for changed available maternal outcomes, suggesting that a maternity care system with a strong midwife-led primary care system may flexibly and safely adapt to external disruptions.