77 Regional variations in childbirth interventions and their correlations Variations in childbirth interventions There was a considerable north-south divide with regard to the place of birth, episiotomy and postpartum administration of oxytocin. Rates of home births were higher in the north of the country than in the south (fig 2), and were negatively correlated with episiotomy (rho = - 0.60; S4 Table). Rates of postpartum administration of oxytocin among women in midwife-led care at the time of birth varied from between 59% to 88% among nulliparous women and from between 50% to 85% among multiparous women (table 1). Overall, among women in midwife-led care, the correlation of actual home birth and postpartum administration of oxytocin was rho = - 0.79 (fig 4). In regions where midwives more frequently administer oxytocin postpartum, overall rates of PPH were not lower (rho = 0.08; S5 Table). For episiotomy, a variation of between 39% and 60% was found in nulliparous women, and of between 10% and 21% among multiparous women. Variation was greatest for women receiving midwife-led care at the time of birth, with rates varying from between 14% to 42% among nulliparous women and from between 3% to 13% among multiparous women. Among women receiving obstetrician-led care, rates varied from between 46% to 67% among nulliparous women and from between 14% to 28% among multiparous (table 1). There was a strong correlation between episiotomy rates in midwife-led and in obstetrician-led care settings within the same region (rho = 0.96, fig 5). The correlation between the adjusted ORs of actual home birth and episiotomy was rho = - 0.60 (S4 Table). We did not find a correlation between the adjusted ORs of episiotomy and third or fourth degree perineal tear in vaginal births (rho = - 0.20; S5 Table and figs 6a and 6b). Least variation was found for AROM among women receiving midwife-led care at the onset of labour (fig 7). Here rates varied from between 43% to 52% among nulliparous women and from between 54% to 61% among multiparous (table 1). Except for the positive correlation between intrapartum referral and PPH (rho = 0.74), correlations with other adverse outcomes were not statistically significant. 3
RkJQdWJsaXNoZXIy MTk4NDMw