Evaluating perinatal outcomes in different levels of care

The safety of the Dutch obstetric system has been subject of debate for many years. The typical obstetric system in the Netherlands is characterized by a formal distinction between independent midwife-led primary care and obstetrician-led secondary care. Pregnant women who are considered low risk are usually looked after in primary care (with referral in case complications arise), although they can also choose to be in secondary care.
In 2010, the discussion regarding the Dutch obstetric system was refuelled, when Evers et al reported higher birth related perinatal mortality rates in term women who started labour in midwife-led versus obstetrician-led care in the Utrecht region of The Netherlands. It was an unexpected finding, as the obstetrician-led care group consisted of women with predominantly high risk pregnancies.
This motivated us to further investigate perinatal mortality rates, but also intervention rates, in community midwife-led versus obstetrician-led care, within the context of the Dutch system. We focused on women with low risk pregnancies in order to reduce heterogeneity between groups. Furthermore, we aimed to gain insight into the pathways leading to perinatal mortality and to identify risk factors for improvement strategies, with the final aim to improve perinatal outcomes.
In the second part of the thesis we explain the importance of translating clinical research into guidelines and vice versa in an ongoing healthcare quality cycle, and present an example of such a guideline.