Variations in use of childbirth interventions in 13 high-income countries : a multinational cross-sectional study
Background: Variations in intervention rates, without subsequent reductions in adverse outcomes, can indicate overuse. We studied variations in and associations between commonly used childbirth interventions and adverse outcomes, adjusted for population characteristics. Methods and findings: In this...
Published in: | PLOS Medicine |
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Main Authors: | , , , , , , , , , , , , , , , , , , , , |
Format: | Article in Journal/Newspaper |
Language: | English |
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Public Library of Science
2020
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Online Access: | https://www.um.edu.mt/library/oar/handle/123456789/58755 https://doi.org/10.1371/journal.pmed.1003103 |
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ftunivmalta:oai:www.um.edu.mt:123456789/58755 |
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Open Polar |
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University of Malta: OAR@UM |
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ftunivmalta |
language |
English |
topic |
Childbirth -- Cross-cultural studies Maternal health services -- Cross-cultural studies Labor (Obstetrics) -- Cross-cultural studies |
spellingShingle |
Childbirth -- Cross-cultural studies Maternal health services -- Cross-cultural studies Labor (Obstetrics) -- Cross-cultural studies Seijmonsbergen-Schermers, Anna E. Akker, Thomas van den Rydahl, Eva Beeckman, Katrien Bogaerts, Annick Binfa, Lorena Frith, Lucy Gross, Mechthild M. Misselwitz, Bjorn Halfdansdottir, Berglind Daly, Deirdre Corcoran, Paul Calleja-Agius, Jean Calleja, Neville Gatt, Miriam Britt Vika Nilsen, Anne Declercq, Eugene Gissler, Mika Heino, Anna Lindgren, Helena Jonge, Ank de Variations in use of childbirth interventions in 13 high-income countries : a multinational cross-sectional study |
topic_facet |
Childbirth -- Cross-cultural studies Maternal health services -- Cross-cultural studies Labor (Obstetrics) -- Cross-cultural studies |
description |
Background: Variations in intervention rates, without subsequent reductions in adverse outcomes, can indicate overuse. We studied variations in and associations between commonly used childbirth interventions and adverse outcomes, adjusted for population characteristics. Methods and findings: In this multinational cross-sectional study, existing data on 4,729,307 singleton births at ≥37 weeks in 2013 from Finland, Sweden, Norway, Denmark, Iceland, Ireland, England, the Netherlands, Belgium, Germany (Hesse), Malta, the United States, and Chile were used to describe variations in childbirth interventions and outcomes. Numbers of births ranged from 3,987 for Iceland to 3,500,397 for the USA. Crude data were analysed in the Netherlands, or analysed data were shared with the principal investigator. Strict variable definitions were used and information on data quality was collected. Intervention rates were described for each country and stratified by parity. Uni- and multivariable analyses were performed, adjusted for population characteristics, and associations between rates of interventions, population characteristics, and outcomes were assessed using Spearman’s rank correlation coefficients. Considerable intercountry variations were found for all interventions, despite adjustments for population characteristics. Adjustments for ethnicity and body mass index changed odds ratios for augmentation of labour and episiotomy. Largest variations were found for augmentation of labour, pain relief, episiotomy, instrumental birth, and cesarean section (CS). Percentages of births at ≥42 weeks varied from 0.1% to 6.7%. Rates among nulliparous versus multiparous women varied from 56% to 80% versus 51% to 82% for spontaneous onset of labour; 14% to 36% versus 8% to 28% for induction of labour; 3% to 13% versus 7% to 26% for prelabour CS; 16% to 48% versus 12% to 50% for overall CS; 22% to 71% versus 7% to 38% for augmentation of labour; 50% to 93% versus 25% to 86% for any intrapartum pain relief, 19% to 83% versus 10% to 64% for epidural anaesthesia; 6% to 68% versus 2% to 30% for episiotomy in vaginal births; 3% to 30% versus 1% to 7% for instrumental vaginal births; and 42% to 70% versus 50% to 84% for spontaneous vaginal births. Countries with higher rates of births at ≥42 weeks had higher rates of births with a spontaneous onset (rho = 0.82 for nulliparous/rho = 0.83 for multiparous women) and instrumental (rho = 0.67) and spontaneous (rho = 0.66) vaginal births among multiparous women and lower rates of induction of labour (rho = −0.71/−0.66), prelabour CS (rho = −0.61/−0.65), overall CS (rho = −0.61/−0.67), and episiotomy (multiparous: rho = −0.67). Variation in CS rates was mainly due to prelabour CS (rho = 0.96). Countries with higher rates of births with a spontaneous onset had lower rates of emergency CS (nulliparous: rho = −0.62) and higher rates of spontaneous vaginal births (multiparous: rho = 0.70). Prelabour and emergency CS were positively correlated (nulliparous: rho = 0.74). Higher rates of obstetric anal sphincter injury following vaginal birth were found in countries with higher rates of spontaneous birth (nulliparous: rho = 0.65). In countries with higher rates of epidural anaesthesia (nulliparous) and spontaneous births (multiparous), higher rates of Apgar score < 7 were found (rhos = 0.64). No statistically significant variation was found for perinatal mortality. Main limitations were varying quality of data and missing information. Conclusions: Considerable intercountry variations were found for all interventions, even after adjusting for population characteristics, indicating overuse of interventions in some countries. Multivariable analyses are essential when comparing intercountry rates. Implementation of evidence-based guidelines is crucial in optimising intervention use and improving quality of maternity care worldwide. peer-reviewed |
format |
Article in Journal/Newspaper |
author |
Seijmonsbergen-Schermers, Anna E. Akker, Thomas van den Rydahl, Eva Beeckman, Katrien Bogaerts, Annick Binfa, Lorena Frith, Lucy Gross, Mechthild M. Misselwitz, Bjorn Halfdansdottir, Berglind Daly, Deirdre Corcoran, Paul Calleja-Agius, Jean Calleja, Neville Gatt, Miriam Britt Vika Nilsen, Anne Declercq, Eugene Gissler, Mika Heino, Anna Lindgren, Helena Jonge, Ank de |
author_facet |
Seijmonsbergen-Schermers, Anna E. Akker, Thomas van den Rydahl, Eva Beeckman, Katrien Bogaerts, Annick Binfa, Lorena Frith, Lucy Gross, Mechthild M. Misselwitz, Bjorn Halfdansdottir, Berglind Daly, Deirdre Corcoran, Paul Calleja-Agius, Jean Calleja, Neville Gatt, Miriam Britt Vika Nilsen, Anne Declercq, Eugene Gissler, Mika Heino, Anna Lindgren, Helena Jonge, Ank de |
author_sort |
Seijmonsbergen-Schermers, Anna E. |
title |
Variations in use of childbirth interventions in 13 high-income countries : a multinational cross-sectional study |
title_short |
Variations in use of childbirth interventions in 13 high-income countries : a multinational cross-sectional study |
title_full |
Variations in use of childbirth interventions in 13 high-income countries : a multinational cross-sectional study |
title_fullStr |
Variations in use of childbirth interventions in 13 high-income countries : a multinational cross-sectional study |
title_full_unstemmed |
Variations in use of childbirth interventions in 13 high-income countries : a multinational cross-sectional study |
title_sort |
variations in use of childbirth interventions in 13 high-income countries : a multinational cross-sectional study |
publisher |
Public Library of Science |
publishDate |
2020 |
url |
https://www.um.edu.mt/library/oar/handle/123456789/58755 https://doi.org/10.1371/journal.pmed.1003103 |
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ENVELOPE(-63.000,-63.000,-64.300,-64.300) |
geographic |
Norway Rho |
geographic_facet |
Norway Rho |
genre |
Iceland |
genre_facet |
Iceland |
op_relation |
Seijmonsbergen-Schermers, A. E., van den Akker, T., Rydahl, E., Beeckman, K., Bogaerts, A., Binfa, L.,… de Jonge, A. (2020). Variations in use of childbirth interventions in 13 high-income countries : a multinational cross-sectional study. PLOS Medicine, 17(5), e1003103. https://www.um.edu.mt/library/oar/handle/123456789/58755 doi:10.1371/journal.pmed.1003103 |
op_rights |
info:eu-repo/semantics/openAccess The copyright of this work belongs to the author(s)/publisher. The rights of this work are as defined by the appropriate Copyright Legislation or as modified by any successive legislation. Users may access this work and can make use of the information contained in accordance with the Copyright Legislation provided that the author must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the prior permission of the copyright holder. |
op_doi |
https://doi.org/10.1371/journal.pmed.1003103 |
container_title |
PLOS Medicine |
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17 |
container_issue |
5 |
container_start_page |
e1003103 |
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1766041440726548480 |
spelling |
ftunivmalta:oai:www.um.edu.mt:123456789/58755 2023-05-15T16:51:20+02:00 Variations in use of childbirth interventions in 13 high-income countries : a multinational cross-sectional study Seijmonsbergen-Schermers, Anna E. Akker, Thomas van den Rydahl, Eva Beeckman, Katrien Bogaerts, Annick Binfa, Lorena Frith, Lucy Gross, Mechthild M. Misselwitz, Bjorn Halfdansdottir, Berglind Daly, Deirdre Corcoran, Paul Calleja-Agius, Jean Calleja, Neville Gatt, Miriam Britt Vika Nilsen, Anne Declercq, Eugene Gissler, Mika Heino, Anna Lindgren, Helena Jonge, Ank de 2020 https://www.um.edu.mt/library/oar/handle/123456789/58755 https://doi.org/10.1371/journal.pmed.1003103 en eng Public Library of Science Seijmonsbergen-Schermers, A. E., van den Akker, T., Rydahl, E., Beeckman, K., Bogaerts, A., Binfa, L.,… de Jonge, A. (2020). Variations in use of childbirth interventions in 13 high-income countries : a multinational cross-sectional study. PLOS Medicine, 17(5), e1003103. https://www.um.edu.mt/library/oar/handle/123456789/58755 doi:10.1371/journal.pmed.1003103 info:eu-repo/semantics/openAccess The copyright of this work belongs to the author(s)/publisher. The rights of this work are as defined by the appropriate Copyright Legislation or as modified by any successive legislation. Users may access this work and can make use of the information contained in accordance with the Copyright Legislation provided that the author must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the prior permission of the copyright holder. Childbirth -- Cross-cultural studies Maternal health services -- Cross-cultural studies Labor (Obstetrics) -- Cross-cultural studies article 2020 ftunivmalta https://doi.org/10.1371/journal.pmed.1003103 2021-10-16T18:10:04Z Background: Variations in intervention rates, without subsequent reductions in adverse outcomes, can indicate overuse. We studied variations in and associations between commonly used childbirth interventions and adverse outcomes, adjusted for population characteristics. Methods and findings: In this multinational cross-sectional study, existing data on 4,729,307 singleton births at ≥37 weeks in 2013 from Finland, Sweden, Norway, Denmark, Iceland, Ireland, England, the Netherlands, Belgium, Germany (Hesse), Malta, the United States, and Chile were used to describe variations in childbirth interventions and outcomes. Numbers of births ranged from 3,987 for Iceland to 3,500,397 for the USA. Crude data were analysed in the Netherlands, or analysed data were shared with the principal investigator. Strict variable definitions were used and information on data quality was collected. Intervention rates were described for each country and stratified by parity. Uni- and multivariable analyses were performed, adjusted for population characteristics, and associations between rates of interventions, population characteristics, and outcomes were assessed using Spearman’s rank correlation coefficients. Considerable intercountry variations were found for all interventions, despite adjustments for population characteristics. Adjustments for ethnicity and body mass index changed odds ratios for augmentation of labour and episiotomy. Largest variations were found for augmentation of labour, pain relief, episiotomy, instrumental birth, and cesarean section (CS). Percentages of births at ≥42 weeks varied from 0.1% to 6.7%. Rates among nulliparous versus multiparous women varied from 56% to 80% versus 51% to 82% for spontaneous onset of labour; 14% to 36% versus 8% to 28% for induction of labour; 3% to 13% versus 7% to 26% for prelabour CS; 16% to 48% versus 12% to 50% for overall CS; 22% to 71% versus 7% to 38% for augmentation of labour; 50% to 93% versus 25% to 86% for any intrapartum pain relief, 19% to 83% versus 10% to 64% for epidural anaesthesia; 6% to 68% versus 2% to 30% for episiotomy in vaginal births; 3% to 30% versus 1% to 7% for instrumental vaginal births; and 42% to 70% versus 50% to 84% for spontaneous vaginal births. Countries with higher rates of births at ≥42 weeks had higher rates of births with a spontaneous onset (rho = 0.82 for nulliparous/rho = 0.83 for multiparous women) and instrumental (rho = 0.67) and spontaneous (rho = 0.66) vaginal births among multiparous women and lower rates of induction of labour (rho = −0.71/−0.66), prelabour CS (rho = −0.61/−0.65), overall CS (rho = −0.61/−0.67), and episiotomy (multiparous: rho = −0.67). Variation in CS rates was mainly due to prelabour CS (rho = 0.96). Countries with higher rates of births with a spontaneous onset had lower rates of emergency CS (nulliparous: rho = −0.62) and higher rates of spontaneous vaginal births (multiparous: rho = 0.70). Prelabour and emergency CS were positively correlated (nulliparous: rho = 0.74). Higher rates of obstetric anal sphincter injury following vaginal birth were found in countries with higher rates of spontaneous birth (nulliparous: rho = 0.65). In countries with higher rates of epidural anaesthesia (nulliparous) and spontaneous births (multiparous), higher rates of Apgar score < 7 were found (rhos = 0.64). No statistically significant variation was found for perinatal mortality. Main limitations were varying quality of data and missing information. Conclusions: Considerable intercountry variations were found for all interventions, even after adjusting for population characteristics, indicating overuse of interventions in some countries. Multivariable analyses are essential when comparing intercountry rates. Implementation of evidence-based guidelines is crucial in optimising intervention use and improving quality of maternity care worldwide. peer-reviewed Article in Journal/Newspaper Iceland University of Malta: OAR@UM Norway Rho ENVELOPE(-63.000,-63.000,-64.300,-64.300) PLOS Medicine 17 5 e1003103 |