Birth Centre care : opening the black box

In the Netherlands, pregnant women with a low-risk of complications can choose where they would like to give birth; at home, in a hospital or in a birth centre, all accompanied by a community midwife. During the last years, more women are planning birth out of home because they do not feel safe at home or are asking for a referral to get pain relief. In the last 15 years, there was a rapid increase in the number of birth centres. Birth centres have been established because of various reasons, including a more homelike environment than in a hospital, competition with neighbouring hospitals, additional facilities during childbirth (like a bath and nitrous oxide) and to reduce the pressure on the capacity of hospital maternity wards. It has been assumed that birth centres provide better quality of care due to better collaboration, when compared to the existing system of primary and secondary maternity care. Scientific evidence on this assumption was missing.

This thesis consist of four objectives:
1) To study the organizational processes in a limited number of birth centres.
2) To study maternal and perinatal outcomes by planned birth in a birth centre compared with planned birth in a hospital and at home by using, among others the optimality index and a composite adverse outcome score.
3) To study the cost-effectiveness of planned birth in a birth centre compared with planned birth in a hospital and at home.
4) To evaluate the client experiences with care of planned birth in a birth centre compared with planned birth in a hospital and at home.