Variations in childbirth interventions in high-income countries: Protocol for a multinational cross-sectional study

Anna Seijmonsbergen-Schermers; Ank De Jonge; Thomas Van Den Akker; Katrien Beeckman; Annick Bogaerts; Monalisa Barros; Patricia Janssen; Lorena Binfa; Eva Rydahl; Lucy Frith; Mechthild Gross; Berglind Hálfdánsdóttir; Deirdre Daly; Jean Calleja-Agius; Patricia Gillen; Anne Britt Vika Nilsen; Eugene Declercq

doi:10.1136/bmjopen-2017-017993

Variations in childbirth interventions in high-income countries: Protocol for a multinational cross-sectional study

Anna Seijmonsbergen-Schermers^*, Ank De Jonge, Thomas Van Den Akker, Katrien Beeckman, Annick Bogaerts, Monalisa Barros, Patricia Janssen, Lorena Binfa, Eva Rydahl, Lucy Frith, Mechthild Gross, Berglind Hálfdánsdóttir, Deirdre Daly, Jean Calleja-Agius, Patricia Gillen, Anne Britt Vika Nilsen, Eugene Declercq

^*Corresponding author for this work

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Introduction There are growing concerns about the increase in rates of commonly used childbirth interventions. When indicated, childbirth interventions are crucial for preventing maternal and perinatal morbidity and mortality, but their routine use in healthy women and children leads to avoidable maternal and neonatal harm. Establishing ideal rates of interventions can be challenging. This study aims to describe the range of variations in the use of commonly used childbirth interventions in high-income countries around the world, and in outcomes in nulliparous and multiparous women. Methods and analysis This multinational cross-sectional study will use data from births in 2013 with national population data or representative samples of the population of pregnant women in high-income countries. Data from women who gave birth to a single child from 37 weeks gestation onwards will be included and the results will be presented for nulliparous and multiparous women separately. Anonymised individual level data will be analysed. Primary outcomes are rates of commonly used childbirth interventions, including induction and/or augmentation of labour, intrapartum antibiotics, epidural and pharmacological pain relief, episiotomy in vaginal births, instrument-assisted birth (vacuum or forceps), caesarean section and use of oxytocin postpartum. Secondary outcomes are maternal and perinatal mortality, Apgar score below 7 at 5 min, postpartum haemorrhage and obstetric anal sphincter injury. Univariable and multivariable logistic regression analyses will be conducted to investigate variations among countries, adjusted for maternal age, body mass index, gestational weight gain, ethnic background, socioeconomic status and infant birth weight. The overall mean rates will be considered as a reference category, weighted for the size of the study population per country. Ethics and dissemination The Medical Ethics Review Committee of VU University Medical Center Amsterdam confirmed that an official approval of this study was not required. Results will be disseminated at national and international conferences and published in peer-reviewed journals.

Original language	English
Article number	017993
Journal	BMJ Open
Volume	8
Issue number	1
DOIs	https://doi.org/10.1136/bmjopen-2017-017993
Publication status	Published - 1 Jan 2018
Externally published	Yes

Funding

1Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands 2Department of Midwifery Science, VU University Medical Center, Amsterdam, The Netherlands 3Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands 4Nursing and Midwifery Research Unit, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussel, Belgium 5Department of Development and Regeneration KU Leuven, University of Leuven, Leuven, Belgium 6Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Antwerp, Belgium 7Faculty of Health and Social Work, Research Unit Healthy Living, Uc Leuven-Limburg, Leuven, Belgium 8Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista, Brazil 9University of British Columbia, Vancouver, Canada 10Department of Women’s and New Born Health Promotion-School of Midwifery Faculty of Medicine, University of Chile, Santiago, Chile 11Department of Midwifery, Metropolitan University College, Copenhagen, Denmark 12Department of Health Services Research, The University of Liverpool, Liverpool, UK 13Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology and Reproductive Medicine, Hannover Medical School, Hannover, Germany 14Midwifery Programme, Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland 15School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland 16Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Tal-Qroqq, Malta 17Institute of Nursing and Health Research, Ulster University, Jordanstown, UK 18Western Norway University of Applied Sciences (HVL), Bergen, Norway 19Boston University School of Public Health, Boston, Massachusetts, USA Acknowledgements We acknowledge the contribution of F Schellevis for his input and advice into the design of this study. We also acknowledge the contribution of: M Willems from Statistics Belgium, Federal Public Services and the ‘Gemeenschappelijke Gemeenschapscommissie voor de geboorten en overlijdens in het Brusselse Gewest’, the ‘Vlaamse Gemeenschap’ and ‘the Federatie Wallonië-Brussel’ for providing the data for Belgium; DataSus and Fiocruz for providing the data for Brazil; The Canadian Institute for Health Information for providing the data for Canada; The Ministry of Health Chile (2013), Department of Statistics and Health Information, Data Base of Birth and Hospital Discharges 2013 for providing the data for Chile; The Statistics Denmark for providing the data for Denmark; The Health and Social care information centre - Hospital Episode Statistics NHS Maternity Statistics – England, 2013-14 for providing the data for England; Geschaeftsstelle Qualitaetssicherung Hessen (Institute for Quality Assurance Hesse) for providing the data for Germany; The Icelandic National Birth Registry for providing the data for Iceland; The Healthcare Pricing Office for providing the data for Ireland; The Department of Health Information and Research for providing data from the National Obstetric Information System (NOIS) for Malta; The Netherlands Perinatal Registry for providing the data for the Netherlands; The Northern Ireland Statistics & Research Agency NISRA for providing the data for Northern Ireland; The Medical Birth Registry of Norway and Statistics Norway for providing the data for Norway; The National Vital Statistics System for providing the data for the United States. This article is based upon work from COST Action IS1405 ‘BIRTH’: “Building Intrapartum Research Through Health - an interdisciplinary whole system approach to understanding and contextualising physiological labour and birth” (http://www. cost.eu/COST_Actions/isch/IS1405), supported by COST (European Cooperation in Science and Technology). Funding The study was developed during a meeting with COST-members (European Cooperation in Science and Technology). These meetings are funded by the COST Action IS1405 ‘BIRTH’ (European Cooperation in Science and Technology). There is no other external funding for this study. Competing interests None declared. Ethics approval Medical Ethics Review Committee of the VU University Medical Center Amsterdam. Provenance and peer review Not commissioned; externally peer reviewed.

Keywords

caesarean section
childbirth interventions
episiotomy
instrumental delivery
international variations
maternal and perinatal outcmes

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Seijmonsbergen-Schermers, A., De Jonge, A., Van Den Akker, T., Beeckman, K., Bogaerts, A., Barros, M., Janssen, P., Binfa, L., Rydahl, E., Frith, L., Gross, M., Hálfdánsdóttir, B., Daly, D., Calleja-Agius, J., Gillen, P., Vika Nilsen, A. B., & Declercq, E. (2018). Variations in childbirth interventions in high-income countries: Protocol for a multinational cross-sectional study. BMJ Open, 8(1), Article 017993. https://doi.org/10.1136/bmjopen-2017-017993

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abstract = "Introduction There are growing concerns about the increase in rates of commonly used childbirth interventions. When indicated, childbirth interventions are crucial for preventing maternal and perinatal morbidity and mortality, but their routine use in healthy women and children leads to avoidable maternal and neonatal harm. Establishing ideal rates of interventions can be challenging. This study aims to describe the range of variations in the use of commonly used childbirth interventions in high-income countries around the world, and in outcomes in nulliparous and multiparous women. Methods and analysis This multinational cross-sectional study will use data from births in 2013 with national population data or representative samples of the population of pregnant women in high-income countries. Data from women who gave birth to a single child from 37 weeks gestation onwards will be included and the results will be presented for nulliparous and multiparous women separately. Anonymised individual level data will be analysed. Primary outcomes are rates of commonly used childbirth interventions, including induction and/or augmentation of labour, intrapartum antibiotics, epidural and pharmacological pain relief, episiotomy in vaginal births, instrument-assisted birth (vacuum or forceps), caesarean section and use of oxytocin postpartum. Secondary outcomes are maternal and perinatal mortality, Apgar score below 7 at 5 min, postpartum haemorrhage and obstetric anal sphincter injury. Univariable and multivariable logistic regression analyses will be conducted to investigate variations among countries, adjusted for maternal age, body mass index, gestational weight gain, ethnic background, socioeconomic status and infant birth weight. The overall mean rates will be considered as a reference category, weighted for the size of the study population per country. Ethics and dissemination The Medical Ethics Review Committee of VU University Medical Center Amsterdam confirmed that an official approval of this study was not required. Results will be disseminated at national and international conferences and published in peer-reviewed journals.",

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Seijmonsbergen-Schermers, A, De Jonge, A, Van Den Akker, T, Beeckman, K, Bogaerts, A, Barros, M, Janssen, P, Binfa, L, Rydahl, E, Frith, L, Gross, M, Hálfdánsdóttir, B, Daly, D, Calleja-Agius, J, Gillen, P, Vika Nilsen, AB & Declercq, E 2018, 'Variations in childbirth interventions in high-income countries: Protocol for a multinational cross-sectional study', BMJ Open, vol. 8, no. 1, 017993. https://doi.org/10.1136/bmjopen-2017-017993

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AU - Seijmonsbergen-Schermers, Anna

AU - De Jonge, Ank

AU - Van Den Akker, Thomas

AU - Beeckman, Katrien

AU - Bogaerts, Annick

AU - Barros, Monalisa

AU - Janssen, Patricia

AU - Binfa, Lorena

AU - Rydahl, Eva

AU - Frith, Lucy

AU - Gross, Mechthild

AU - Hálfdánsdóttir, Berglind

AU - Daly, Deirdre

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N2 - Introduction There are growing concerns about the increase in rates of commonly used childbirth interventions. When indicated, childbirth interventions are crucial for preventing maternal and perinatal morbidity and mortality, but their routine use in healthy women and children leads to avoidable maternal and neonatal harm. Establishing ideal rates of interventions can be challenging. This study aims to describe the range of variations in the use of commonly used childbirth interventions in high-income countries around the world, and in outcomes in nulliparous and multiparous women. Methods and analysis This multinational cross-sectional study will use data from births in 2013 with national population data or representative samples of the population of pregnant women in high-income countries. Data from women who gave birth to a single child from 37 weeks gestation onwards will be included and the results will be presented for nulliparous and multiparous women separately. Anonymised individual level data will be analysed. Primary outcomes are rates of commonly used childbirth interventions, including induction and/or augmentation of labour, intrapartum antibiotics, epidural and pharmacological pain relief, episiotomy in vaginal births, instrument-assisted birth (vacuum or forceps), caesarean section and use of oxytocin postpartum. Secondary outcomes are maternal and perinatal mortality, Apgar score below 7 at 5 min, postpartum haemorrhage and obstetric anal sphincter injury. Univariable and multivariable logistic regression analyses will be conducted to investigate variations among countries, adjusted for maternal age, body mass index, gestational weight gain, ethnic background, socioeconomic status and infant birth weight. The overall mean rates will be considered as a reference category, weighted for the size of the study population per country. Ethics and dissemination The Medical Ethics Review Committee of VU University Medical Center Amsterdam confirmed that an official approval of this study was not required. Results will be disseminated at national and international conferences and published in peer-reviewed journals.

AB - Introduction There are growing concerns about the increase in rates of commonly used childbirth interventions. When indicated, childbirth interventions are crucial for preventing maternal and perinatal morbidity and mortality, but their routine use in healthy women and children leads to avoidable maternal and neonatal harm. Establishing ideal rates of interventions can be challenging. This study aims to describe the range of variations in the use of commonly used childbirth interventions in high-income countries around the world, and in outcomes in nulliparous and multiparous women. Methods and analysis This multinational cross-sectional study will use data from births in 2013 with national population data or representative samples of the population of pregnant women in high-income countries. Data from women who gave birth to a single child from 37 weeks gestation onwards will be included and the results will be presented for nulliparous and multiparous women separately. Anonymised individual level data will be analysed. Primary outcomes are rates of commonly used childbirth interventions, including induction and/or augmentation of labour, intrapartum antibiotics, epidural and pharmacological pain relief, episiotomy in vaginal births, instrument-assisted birth (vacuum or forceps), caesarean section and use of oxytocin postpartum. Secondary outcomes are maternal and perinatal mortality, Apgar score below 7 at 5 min, postpartum haemorrhage and obstetric anal sphincter injury. Univariable and multivariable logistic regression analyses will be conducted to investigate variations among countries, adjusted for maternal age, body mass index, gestational weight gain, ethnic background, socioeconomic status and infant birth weight. The overall mean rates will be considered as a reference category, weighted for the size of the study population per country. Ethics and dissemination The Medical Ethics Review Committee of VU University Medical Center Amsterdam confirmed that an official approval of this study was not required. Results will be disseminated at national and international conferences and published in peer-reviewed journals.

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Variations in childbirth interventions in high-income countries: Protocol for a multinational cross-sectional study

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