Regional practice variation in induction of labor in the Netherlands: Does it matter? A multilevel analysis of the association between induction rates and perinatal and maternal outcomes

Offerhaus, Pien; van Haaren-Ten Haken, Tamar M.; Keulen, Judit K.J.; de Jong, Judith D.; Brabers, Anne E.M.; Verhoeven, Corine J.M.; Scheepers, Hubertina C.J.; Nieuwenhuijze, Marianne

Abstract

Background
Practice variation in healthcare is a complex issue. We focused on practice variation in induction of labor between maternity care networks in the Netherlands. These collaborations of hospitals and midwifery practices are jointly responsible for providing high-quality maternity care. We explored the association between induction rates and maternal and perinatal outcomes.

Methods
In a retrospective population-based cohort study, we included records of 184,422 women who had a singleton, vertex birth of their first child after a gestation of at least 37 weeks in the years 2016–2018. We calculated induction rates for each maternity care network. We divided networks in induction rate categories: lowest (Q1), moderate (Q2-3) and highest quartile (Q4). We explored the association of these categories with unplanned caesarean sections, unfavorable maternal outcomes and adverse perinatal outcomes using descriptive statistics and multilevel logistic regression analysis corrected for population characteristics.

Findings
The induction rate ranged from 14.3% to 41.1% (mean 24.4%, SD 5.3). Women in Q1 had fewer unplanned caesarean sections (Q1: 10.2%, Q2-3: 12.1%; Q4: 12.8%), less unfavorable maternal outcomes (Q1: 33.8%; Q2-3: 35.7%; Q4: 36.3%) and less adverse perinatal outcomes (Q1: 1.0%; Q2-3: 1.1%; Q4: 1.3%). The multilevel analysis showed a lower unplanned caesarean section rate in Q1 in comparison with reference category Q2-3 (OR 0.83; p = .009). The unplanned caesarean section rate in Q4 was similar to the reference category. No significant associations with unfavorable maternal or adverse perinatal outcomes were observed.

Conclusion
Practice variation in labor induction is high in Dutch maternity care networks, with limited association with maternal outcomes and no association with perinatal outcomes. Networks with low induction rates had lower unplanned caesarean section rates compared to networks with moderate rates. Further in-depth research is necessary to understand the mechanisms that contribute to practice variation and the observed association with unplanned caesarean sections.

Citation

Offerhaus, P., van Haaren-Ten Haken, T. M., Keulen, J. K., de Jong, J. D., Brabers, A. E., Verhoeven, C. J., …Nieuwenhuijze, M. (2023). Regional practice variation in induction of labor in the Netherlands: Does it matter? A multilevel analysis of the association between induction rates and perinatal and maternal outcomes. PLoS ONE, 18(6), Article e0286863. https://doi.org/10.1371/journal.pone.0286863

• Journal Article Type: Article
• Acceptance Date: May 25, 2023
• Online Publication Date: Jun 8, 2023
• Publication Date: Jun 8, 2023
• Deposit Date: Jul 12, 2023
• Publicly Available Date: Jul 14, 2023
• Journal: PLoS ONE
• Electronic ISSN: 1932-6203
• Publisher: Public Library of Science
• Peer Reviewed: Peer Reviewed
• Volume: 18
• Issue: 6
• Article Number: e0286863
• DOI: https://doi.org/10.1371/journal.pone.0286863
• Keywords: Labor and delivery; Birth; Pregnancy complication; Primary care; Pregnancy; Netherlands; Hypertensive disorders in pregnancy; Decision making
• Public URL: https://nottingham-repository.worktribe.com/output/21646287
• Publisher URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0286863