Intrapartum and neonatal mortality among low-risk women in midwife-led versus obstetrician-led care in the Amsterdam region of the Netherlands: a propensity score matched study
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  • Published on:
    Lack of reliable data confuses discussion on safety of midwife-led and obstetrician-led care
    • Ank De Jonge, Associate professor Midwifery Science Department of Midwifery Science AVAG/ Amsterdam Public Health research institute VU University Medical Center Amsterdam.
    • Other Contributors:
      • Francois Schellevis, Professor of General Practice

    With interest we read the article of Wiegerinck et al. on intrapartum and neonatal mortality among low-risk women in midwife-led versus obstetrician-led care based on case notes and data from the Dutch national perinatal database (PRN, nowadays called ‘Perined’). In a recent commentary we addressed some important pitfalls associated with the use of register-based data.1 Although the authors acknowledge the methodological challenges of their study, and the limitations of the Perined database, it is important to specify these issues in more detail. Secondly, we want to challenge the interpretation of the findings.
    In this study clinical information regarding the women and babies in the numerators and denominators for intrapartum and neonatal mortality rates were derived from different sources. For the numerators information on women and their babies who died was taken from case notes. For the denominators information was taken from the Perined database, in which information on risk factors is often missing. The authors show in their supplementary file that in a sample of 100 women who started labour in obstetrician-led care no information was recorded for 13% of women on one or more of the eight risk factors which were defined as exclusion criteria in this study. Most women with risk factors will have been removed from the numerator, because information was available in their case notes. On the other hand, an unknown number of women with risk factors were not removed f...

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    Conflict of Interest:
    None declared.