46 Chapter 2 could be used to explore subgroups of women that account for the greatest variation (70). Limited variation in some of the interventions in our study may indicate consensus about its use. However, variations may be greater between midwifery practices, hospitals, collaborations or care providers, than between regions where variations between organisations and practitioners will have been averaged. In further research, variations within the regions should therefore be investigated. Conclusions The greatest variation was found for the type of pain medication and the involvement of a paediatrician, and the least for instrumental vaginal birth and intrapartum CS rates. The rates of adverse outcomes were not lower in regions with higher intervention rates. Care providers should critically audit remarkable variations, since these may be unwarranted. Variation may be explained to some extent by a difference in the degree of implementation of national guidelines between regions. Further research should therefore focus on variations in evidence-based interventions and indications for the use of interventions in childbirth.
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