Pregnancy Clinical Trial
Official title:
Home or Home-like Hospital Birth for Low-risk Nulliparae: Does it Matter?
In the Netherlands, which has about 200.000 births per year, maternity care is provided by
midwives or general practitioners unless medical reasons necessitate specialist obstetric
care. Women with low risk pregnancies are free to decide where to give birth, attended by
their midwife or general practitioner, at home or in the hospital, from which they are then
discharged within 24 hours. In the Netherlands these hospital births are referred to as
"poliklinische bevallingen" (i.e. outpatient deliveries) to indicate that they do not
involve formal hospitalisation, or as "verplaatste thuisbevalling" (i.e. relocated home
births) to indicate that they are supervised by the same caregivers as the home births
without involvement of specialist obstetricians.
In the last two decades a marked increase in the referral rate to obstetricians during
childbirth has occurred, especially for nulliparae, both in planned home births and planned
hospital births (outpatient deliveries). 90% from all primigravidae will start their
pregnancy under care of the primary caregiver (midwife of general practitioner). During the
pregnancy 30% will be referred to the secondary caregiver (obstetrician specialist). The
other 60% will start labor guided by the primary caregiver. More than 50% of these women
will be referred to the obstetrician during labor.
Despite this unique situation of the Dutch maternity care, the differences between home and
hospital birth (outpatient deliveries) with regard to effectivity and efficiency have never
been investigated. It is also unclear if pregnant women are informed about a 50% risk of
being transported to the secondary caregiver/ hospital during labor at home. Neither do we
know what their experiences are.
This study aims to investigate the differences between home and hospital deliveries under
care of the primary caregiver with regard to effectivity (costs) and efficiency (patient
satisfaction) of care.
n/a
Observational Model: Cohort, Time Perspective: Prospective
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