72 Chapter 3 Variations in referral and place of birth Table 1 shows the rates of the primary outcomes for each region. In nulliparous women, variations in regions were found of between 84% and 93% for being in midwife-led care at the onset of pregnancy, of between 47% and 61% at the onset of labour, and of between 17% and 26% at the time of birth. These rates were similar for multiparous women, with the exception that there were higher levels for women receiving midwife-led care at the time of birth, with a variation of between 33% and 43%. Correlations are shown in S4 and S5 Tables, which are available in the supplementary material. In regions with more women in midwife-led care at the onset of labour, there were more births in midwife-led care (rho = 0.84) and more home births (rho = 0.69; S4 Table). Adjusted ORs of variations in the rates of primary outcomes can be found in S3 Tables. Adverse neonatal and maternal outcomes have been described in a previous article (23). A visualisation of the adjusted ORs is provided in figs 2 to 7. Fig 3 shows that in eight regions the number of women in midwife-led care at the onset of labour was negatively correlated with intrapartum referral rates to obstetrician-led care, but the overall correlation was not significant (rho = - 0.40; S4 Table). Rates of intrapartum referrals from midwife-led to obstetrician-led care varied from between 55% to 68% for nulliparous and from between 20% to 32% for multiparous women (table 1). The correlations are shown in S5 Table. In regions where referral rates were higher, rates of PPH were higher as well (rho = 0.74; S5 Table). Rates of planned home births varied from between 7% to 30% among nulliparous and from between 11% to 32% among multiparous women. For actual home birth, rates varied from between 6% to 16% among nulliparous and from between 16% to 31% among multiparous women (table 1). Planned and actual home birth were strongly correlated with each other (rho = 0.98; S4 Table).
RkJQdWJsaXNoZXIy MTk4NDMw