Background: The use of interventions in childbirth has increased the past decades. There is concern that some\nwomen might receive more interventions than they really need. For low-risk women, midwife-led birth settings\nmay be of importance as a counterbalance towards the increasing rate of interventions. The effect of planned place\nof birth on interventions in the Netherlands is not yet clear. This study aims to give insight into differences in\nobstetric interventions and maternal outcomes for planned home versus planned hospital birth among women in\nmidwife-led care.\nMethods: Women from twenty practices across the Netherlands were included in 2009 and 2010. Of these, 3495\nwere low-risk and in midwife-led care at the onset of labour. Information about planned place of birth and\noutcomes, including instrumental birth (caesarean section, vacuum or forceps birth), labour augmentation,\nepisiotomy, oxytocin in third stage, postpartum haemorrhage >1000 ml and perineal damage, came from the\nnational midwife-led care perinatal database, and a postpartum questionnaire.\nResults: Women who planned home birth more often had spontaneous birth (nulliparous women aOR 1.38, 95 % CI\n1.08ââ?¬â??1.76, parous women aOR 2.29, 95 % CI 1.21ââ?¬â??4.36) and less often episiotomy (nulliparous women aOR 0.73, 0.58ââ?¬â??0.\n91, parous women aOR 0.47, 0.33ââ?¬â??0.68) and use of oxytocin in the third stage (nulliparous women aOR 0.58, 0.42ââ?¬â??0.80,\nparous women aOR 0.47, 0.37ââ?¬â??0.60) compared to women who planned hospital birth. Nulliparous women more often\nhad anal sphincter damage (aOR 1.75, 1.01ââ?¬â??3.03), but the difference was not statistically significant if women who had\ncaesarean sections were excluded. Parous women less often had labour augmentation (aOR 0.55, 0.36ââ?¬â??0.82) and more\noften an intact perineum (aOR 1.65, 1.34ââ?¬â??2.03). There were no differences in rates of vacuum/forceps birth, unplanned\ncaesarean section and postpartum haemorrhage >1000 ml.\nConclusions: Women who planned home birth were more likely to give birth spontaneously and had fewer medical\ninterventions.
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