Background Variations in childbirth interventions may indicate inappropriate use. Most variation studies are limited by the lack of adjustments for maternal characteristics and do not investigate variations in adverse outcomes. This study aims to explore regional variations in the Netherlands and their correlations with referral rates, birthplace, interventions, and adverse outcomes, adjusted for maternal characteristics. Methods In this nationwide retrospective cohort study, using a national data register, intervention rates were analysed between twelve regions among single childbirths after 37 weeks’ gestation in 2010–2013 (n = 614,730). These were adjusted for maternal characteristics using multivariable logistic regression. Primary outcomes were intrapartum referral, birthplace, and interventions used in midwife- and obstetrician-led care. Correlations both between primary outcomes and between adverse outcomes were calculated with Spearman’s rank correlations. Findings Intrapartum referral rates varied between 55–68% (nulliparous) and 20–32% (multiparous women), with a negative correlation with receiving midwife-led care at the onset of labour in two-thirds of the regions. Regions with higher referral rates had higher rates of severe postpartum haemorrhages. Rates of home birth varied between 6–16% (nulliparous) and 16–31% (multiparous), and was negatively correlated with episiotomy and postpartum oxytocin rates. Among midwife-led births, episiotomy rates varied between 14–42% (nulliparous) and 3–13% (multiparous) and in obstetrician-led births from 46–67% and 14–28% respectively. Rates of postpartum oxytocin varied between 59–88% (nulliparous) and 50–85% (multiparous) and artificial rupture of membranes between 43–52% and 54–61% respectively. A north-south gradient was visible with regard to birthplace, episiotomy, and oxytocin. Conclusions Our study suggests that attitudes towards interventions vary, independent of maternal characteristics. Care providers and policy makers need to be aware of reducing unwarranted variation in birthplace, episiotomy and the postpartum use of oxytocin. Further research is needed to identify explanations and explore ways to reduce unwarranted intervention rates.
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Within PREMIUM_EU we have co-responsibility for developing the Regional Development Effects Module (RDEM). This module will map the impact of migration on regional development seen on different variables. To construct the RDEM we have to:1. develop a typology of regions, based on the impact that mobility has on its economic, social and cultural development; and2. detect the causal linkages between regional mobility on the one hand and regional development on the other.In our presentation we will focus on the process to determine relevant regional development indicators that will help in the collection and analysis of relevant data for the period 2010-2022 on NUTS 2 and 3 level. Partners in our project will additionally focus on:1. Analysis of regional networks estimated from Facebook2. Building typology regional development3. Longitudinal causal analysis of mobility4. Integration of case studiesFinally, this will result in:• Online atlas of mobility & development typologies• Report Causal Analysis of mobility development
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Part I consists of an inventory of the current and upcoming policy, where we zoom in from European to national and from regional to local level. Additionally, we look at a number of quantitative accomplishments of the Hanze University of Applied Sciences. This preparatory research is performed as part of the European collaborative project Interreg Europe TraCS3.
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