{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:58:52Z","timestamp":1792101532743,"version":"4.4.0"},"reference-count":51,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T00:00:00Z","timestamp":1678838400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>In the Netherlands, maternity care is divided into midwife-led care (for low-risk women) and obstetrician-led care (for high-risk women). Referrals from midwife-led to obstetrician-led care have increased over the past decade. The majority of women are referred during their pregnancy or labour. Referrals are based on a continuous risk assessment of the health and characteristics of mother and child, yet referral for non-medical factors and characteristics remain unclear. This study investigated which maternal characteristics are associated with women\u2019s referral from midwife-led to obstetrician-led care.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>A retrospective cohort study in one midwife-led care practice in the Netherlands included 1096 low-risk women during January 2015\u201317. The primary outcomes were referral from midwife-led to obstetrician-led care in (1) the antepartum period and (2) the intrapartum period. In total, 11 maternal characteristics were identified. Logistic regression models of referral in each period were fitted and stratified by parity.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>In the antepartum period, referral among nulliparous women was associated with an older maternal age (aOR, 1.07; 95%CI, 1.05\u20131.09), being underweight (0.45; 0.31\u20130.64), overweight (2.29; 1.91\u20132.74), or obese (2.65; 2.06\u20133.42), a preconception period &gt;1 year (1.34; 1.07\u20131.66), medium education level (0.76; 0.58\u20131.00), deprivation (1.87; 1.54\u20132.26), and sexual abuse (1.44; 1.14\u20131.82). Among multiparous women, a referral was associated with being underweight (0.40; 0.26\u20130.60), obese (1.61; 1.30\u20131.98), a preconception period &gt;1 year (1.71; 1.27\u20132.28), employment (1.38; 1.19\u20131.61), deprivation (1.23; 1.03\u20131.46), highest education level (0.63; 0.51\u20130.80), psychological problems (1.24; 1.06\u20131.44), and one or multiple consultations with an obstetrician (0.68; 0.58\u20130.80 and 0.64; 0.54\u20130.76, respectively). In the intrapartum period, referral among nulliparous women was associated with an older maternal age (1.02; 1.00\u20131.05), being underweight (1.67; 1.15\u20132.42), a preconception period &gt;1 year (0.42; 0.31\u20130.57), medium or high level of education (2.09; 1.49\u20132.91 or 1.56; 1.10\u20132.22, respectively), sexual abuse (0.46; 0.33\u20130.63), and multiple consultations with an obstetrician (1.49; 1.15\u20131.94). Among multiparous women, referral was associated with an older maternal age (1.02; 1.00\u20131.04), being overweight (0.65; 0.51\u20130.83), a preconception period &gt;1 year (0.33; 0.17\u20130.65), non-Dutch ethnicity (1.98; 1.61\u20132.45), smoking (0.75; 0.57\u20130.97), sexual abuse (1.49; 1.09\u20132.02), and one or multiple consultations with an obstetrician (1.34; 1.06\u20131.70 and 2.09; 1.63\u20132.69, respectively).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>This exploratory study showed that several non-medical maternal characteristics of low-risk pregnant women are associated with referral from midwife-led to obstetrician-led care, and how these differ by parity and partum period.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0282883","type":"journal-article","created":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T17:48:16Z","timestamp":1678902496000},"page":"e0282883","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Maternal characteristics associated with referral to obstetrician-led care in low-risk pregnant women in the Netherlands: A retrospective cohort study"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8162-3143","authenticated-orcid":true,"given":"Susan","family":"Niessink-Beckers","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corine J.","family":"Verhoeven","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marleen J.","family":"Nahuis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9066-3702","authenticated-orcid":true,"given":"Lisanne A.","family":"Horvat-Gitsels","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5742-7246","authenticated-orcid":true,"given":"Janneke T.","family":"Gitsels-van der Wal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,3,15]]},"reference":[{"key":"pone.0282883.ref001","first-page":"Cd004667","article-title":"Midwife-led continuity models versus other models of care for childbearing women.","volume":"4","author":"J Sandall","year":"2016","journal-title":"The Cochrane database of systematic reviews."},{"key":"pone.0282883.ref002","volume-title":"The National Sentinel Caesarean Section Audit Report","author":"Royal College of Obstetricians and Gynaecologists","year":"2001"},{"key":"pone.0282883.ref003","unstructured":"Perined. Perinatal Care in the Netherlands 2002\u20132021. In Dutch, available from: https:\/\/www.perined.nl\/onderwerpen\/publicaties-perined\/jaarboek-zorg Accessed februari 2018."},{"issue":"3","key":"pone.0282883.ref004","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.jmwh.2010.01.001","article-title":"Pregnancy and Labour in the Dutch Maternity Care System: What Is Normal? The Role Division Between Midwives and Obstetricians.","volume":"55","author":"MP Amelink-Verburg","year":"2010","journal-title":"Journal of Midwifery & Women\u2019s Health."},{"key":"pone.0282883.ref005","first-page":"9","article-title":"Patterns in primary midwife-led care in the Netherlands. Trends and variation in intrapartum referrals.","author":"PM Offerhaus","year":"2015","journal-title":"Radboud University Nijmegen"},{"key":"pone.0282883.ref006","first-page":"91","article-title":"Stichting Perinatale Registratie Nederland. Perinatal Care in the Netherlands 2004.","volume":"2007","author":"SPR Nederland","journal-title":"Drukkery Tessink"},{"key":"pone.0282883.ref007","unstructured":"De Koninklijke Nederlandse Organisatie van Verloskundige\u2014Verloskundig vademecum. 2003 VDA-groep, Apeldoorn. Available from: https:\/\/www.knov.nl\/serve\/file\/knov.nl\/knov_downloads\/769\/file\/Verloskundig%20Vademecum%202003.pdf. Accessed 3 Jan 2018."},{"issue":"1","key":"pone.0282883.ref008","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1186\/s12884-019-2316-5","article-title":"Determinants and underlying causes of frequent attendance in midwife-led care: an exploratory cross-sectional study.","volume":"19","author":"JT Gitsels-van der Wal","year":"2019","journal-title":"BMC pregnancy and childbirth."},{"issue":"7","key":"pone.0282883.ref009","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1111\/j.1471-0528.2009.02202.x","article-title":"A trend analysis in referrals during pregnancy and labour in Dutch midwifery care 1988\u20132004","volume":"116","author":"MP Amelink-Verburg","year":"2009","journal-title":"BJOG: an international journal of obstetrics and gynaecology"},{"issue":"5","key":"pone.0282883.ref010","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1016\/j.midw.2013.06.013","article-title":"Change in primary midwife-led care in the Netherlands in 2000\u20132008: a descriptive study of caesarean sections and other interventions among 789,795 low risk births.","volume":"30","author":"PM Offerhaus","year":"2014","journal-title":"Midwifery"},{"issue":"2","key":"pone.0282883.ref011","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1111\/birt.12160","article-title":"Intrapartum referral from primary to secondary care in the Netherlands: a retrospective cohort study on management of labor and outcomes.","volume":"42","author":"H Perdok","year":"2015","journal-title":"Birth (Berkeley, Calif)."},{"issue":"20","key":"pone.0282883.ref012","first-page":"3304","article-title":"Risk indicators for referral during labor from community midwife to gynecologist: a prospective cohort study.","volume":"29","author":"E Schuit","year":"2016","journal-title":"The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet."},{"issue":"5","key":"pone.0282883.ref013","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.midw.2012.04.001","article-title":"Maternal age >\/ = 45 years and maternal and perinatal outcomes: a review of the evidence.","volume":"29","author":"M. Carolan","year":"2013","journal-title":"Midwifery"},{"issue":"6","key":"pone.0282883.ref014","first-page":"634","article-title":"Maternal age and adverse pregnancy outcome: a cohort study.","volume":"42","author":"A Khalil","year":"2013","journal-title":"Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology."},{"issue":"10","key":"pone.0282883.ref015","doi-asserted-by":"crossref","first-page":"e0186287","DOI":"10.1371\/journal.pone.0186287","article-title":"Advanced maternal age and adverse pregnancy outcomes: A systematic review and meta-analysis.","volume":"12","author":"SC Lean","year":"2017","journal-title":"PloS one."},{"issue":"4","key":"pone.0282883.ref016","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/j.ajog.2018.08.034","article-title":"Maternal age and risk for adverse outcomes","volume":"219","author":"JJ Sheen","year":"2018","journal-title":"American journal of obstetrics and gynecology"},{"issue":"16","key":"pone.0282883.ref017","first-page":"276","article-title":"The Risks Associated With Obesity in Pregnancy.","volume":"115","author":"J Stubert","year":"2018","journal-title":"Deutsches Arzteblatt international."},{"issue":"9","key":"pone.0282883.ref018","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1136\/jech.2008.080408","article-title":"The effect of neighbourhood income and deprivation on pregnancy outcomes in Amsterdam, The Netherlands","volume":"63","author":"C Agyemang","year":"2009","journal-title":"Journal of epidemiology and community health"},{"issue":"1","key":"pone.0282883.ref019","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1186\/s12884-017-1418-1","article-title":"Mother\u2019s education and the risk of several neonatal outcomes: an evidence from an Italian population-based study.","volume":"17","author":"A Cantarutti","year":"2017","journal-title":"BMC pregnancy and childbirth."},{"issue":"4","key":"pone.0282883.ref020","doi-asserted-by":"crossref","first-page":"e019566","DOI":"10.1136\/bmjopen-2017-019566","article-title":"The relationship between intimate partner violence reported at the first antenatal booking visit and obstetric and perinatal outcomes in an ethnically diverse group of Australian pregnant women: a population-based study over 10 years","volume":"8","author":"HG Dahlen","year":"2018","journal-title":"BMJ Open"},{"issue":"1","key":"pone.0282883.ref021","first-page":"125","article-title":"Infertility and the risk of adverse pregnancy outcomes: a systematic review and meta-analysis","volume":"28","author":"L Maclagan","year":"2012","journal-title":"Human Reproduction"},{"issue":"4","key":"pone.0282883.ref022","first-page":"623","article-title":"Working conditions and adverse pregnancy outcome: a meta-analysis.","volume":"95","author":"EL Mozurkewich","year":"2000","journal-title":"Obstetrics & Gynecology."},{"issue":"3","key":"pone.0282883.ref023","first-page":"322","article-title":"Poverty, education, race, and pregnancy outcome.","volume":"14","author":"DA Savitz","year":"2004","journal-title":"Ethnicity & disease."},{"issue":"3","key":"pone.0282883.ref024","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.wombi.2015.02.003","article-title":"The effects of maternal depression, anxiety, and perceived stress during pregnancy on preterm birth: A systematic review","volume":"28","author":"A Staneva","year":"2015","journal-title":"Women and birth: journal of the Australian College of Midwives"},{"issue":"2","key":"pone.0282883.ref025","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1093\/eurpub\/ckq046","article-title":"Ethnic disparity in severe acute maternal morbidity: a nationwide cohort study in the Netherlands.","volume":"21","author":"JJ Zwart","year":"2011","journal-title":"European journal of public health"},{"issue":"10","key":"pone.0282883.ref026","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1016\/j.midw.2015.06.008","article-title":"Assessment and care for non-medical risk factors in current antenatal health care.","volume":"31","author":"AA Vos","year":"2015","journal-title":"Midwifery"},{"issue":"6","key":"pone.0282883.ref027","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1007\/s10654-018-0387-7","article-title":"Antenatal non-medical risk assessment and care pathways to improve pregnancy outcomes: a cluster randomised controlled trial","volume":"33","author":"J Lagendijk","year":"2018","journal-title":"European journal of epidemiology"},{"issue":"1","key":"pone.0282883.ref028","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1186\/s12884-018-2030-8","article-title":"Does a maternal history of abuse before pregnancy affect pregnancy outcomes? A systematic review with meta-analysis.","volume":"18","author":"M Nesari","year":"2018","journal-title":"BMC pregnancy and childbirth."},{"key":"pone.0282883.ref029","unstructured":"Vektis. Postcodetabel achterstandswijken. In Dutch, available from: https:\/\/tog.vektis.nl\/TogDownloads.aspx. Accessed May 2022."},{"key":"pone.0282883.ref030","unstructured":"World Health Organisation\u2014BMI. Available from: https:\/\/wwweurowhoint\/en\/health-topics\/disease-prevention\/nutrition\/a-healthy-lifestyle\/body-mass-index-bmi. Accessed 10 Aug 2021."},{"issue":"3","key":"pone.0282883.ref031","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1111\/birt.12055","article-title":"Persisting rise in referrals during labor in primary midwife-led care in the Netherlands.","volume":"40","author":"PM Offerhaus","year":"2013","journal-title":"Birth (Berkeley, Calif)."},{"issue":"10","key":"pone.0282883.ref032","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1016\/j.jclinepi.2006.01.014","article-title":"Review: a gentle introduction to imputation of missing values","volume":"59","author":"AR Donders","year":"2006","journal-title":"Journal of clinical epidemiology"},{"key":"pone.0282883.ref033","doi-asserted-by":"crossref","first-page":"b2393","DOI":"10.1136\/bmj.b2393","article-title":"Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls","volume":"338","author":"JAC Sterne","year":"2009","journal-title":"BMJ"},{"issue":"4","key":"pone.0282883.ref034","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1007\/s00330-014-3487-0","article-title":"Disadvantages of using the area under the receiver operating characteristic curve to assess imaging tests: a discussion and proposal for an alternative approach.","volume":"25","author":"S Halligan","year":"2015","journal-title":"European radiology."},{"key":"pone.0282883.ref035","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1007\/978-90-368-1534-5","volume-title":"Inleiding in de toegepaste biostatistiek","author":"JWR Twisk","year":"2016"},{"issue":"1","key":"pone.0282883.ref036","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1097\/EDE.0b013e3181c30fb2","article-title":"Assessing the performance of prediction models: a framework for traditional and novel measures.","volume":"21","author":"EW Steyerberg","year":"2010","journal-title":"Epidemiology"},{"issue":"7","key":"pone.0282883.ref037","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1007\/s00134-003-1761-8","article-title":"A readers\u2019 guide to the interpretation of diagnostic test properties: clinical example of sepsis.","volume":"29","author":"JE Fischer","year":"2003","journal-title":"Intensive care medicine."},{"issue":"4857","key":"pone.0282883.ref038","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1126\/science.3287615","article-title":"Measuring the accuracy of diagnostic systems","volume":"240","author":"JA Swets","year":"1988","journal-title":"Science (New York, NY)."},{"issue":"3","key":"pone.0282883.ref039","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1097\/01.AOG.0000152304.39492.1c","article-title":"Obesity-Related Complications in Danish Single Cephalic Term Pregnancies.","volume":"105","author":"L Rode","year":"2005","journal-title":"Obstetrics & Gynecology."},{"issue":"4","key":"pone.0282883.ref040","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1007\/s00404-014-3469-0","article-title":"The effects of maternal age and parity on maternal and neonatal outcome","volume":"291","author":"MS Schimmel","year":"2015","journal-title":"Archives of gynecology and obstetrics"},{"issue":"1","key":"pone.0282883.ref041","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/s00404-010-1587-x","article-title":"The impact of advanced maternal age and parity on obstetric and perinatal outcomes in singleton gestations","volume":"284","author":"Y Wang","year":"2011","journal-title":"Archives of gynecology and obstetrics"},{"key":"pone.0282883.ref042","doi-asserted-by":"crossref","first-page":"104802","DOI":"10.1016\/j.chiabu.2020.104802","article-title":"Child Sexual Abuse and Pregnancy: A Systematic Review of the Literature.","volume":"111","author":"R Brunton","year":"2021","journal-title":"Child Abuse & Neglect."},{"issue":"3","key":"pone.0282883.ref043","doi-asserted-by":"crossref","first-page":"e0229488","DOI":"10.1371\/journal.pone.0229488","article-title":"Regional variations in childbirth interventions and their correlations with adverse outcomes, birthplace and care provider: A nationwide explorative study.","volume":"15","author":"AE Seijmonsbergen-Schermers","year":"2020","journal-title":"PloS one."},{"key":"pone.0282883.ref044","unstructured":"Centraal Bureau voor de Statistiek. 2019. Available from: https:\/\/www.cbs.nl\/en-gb. Accessed 20 Apr 2019."},{"key":"pone.0282883.ref045","unstructured":"C.I. Lanting, J.P. van Wouwe, P. van Dommelen, K.M. van der Pal-de Bruin. Roken tijdens de zwangerschap. TNO: 2016. In Dutch. Available from: https:\/\/www.tno.nl\/media\/6211\/factsheet_roken_tijdens_de_zwangerschap.pdf. Accessed 20 Apr 2019."},{"key":"pone.0282883.ref046","unstructured":"M. Tuithof, R. Siauw, S. van Dorsselaer, K. Monshouwer\u2014Factsheet Monitor Zwangerschap en Middelengebruik. Trimbos instituut: 2017. In Dutch. Available from: file:\/\/\/C:\/Users\/Susan\/Downloads\/factsheet-monitor-zwangerschap\u2014en-middelengebruik_3.pdf. Accessed 20 May 2020."},{"key":"pone.0282883.ref047","volume-title":"Seksuele gezondheid in Nederland","author":"H. de Graaf","year":"2017"},{"issue":"2","key":"pone.0282883.ref048","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1111\/j.1471-0528.1990.tb01741.x","article-title":"Social support and pregnancy outcome","volume":"97","author":"A Oakley","year":"1990","journal-title":"British journal of obstetrics and gynaecology"},{"issue":"4","key":"pone.0282883.ref049","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1097\/01.grf.0000141451.68933.9f","article-title":"Social support and pregnancy outcome: a review of the literature.","volume":"47","author":"ST Orr","year":"2004","journal-title":"Clinical obstetrics and gynecology."},{"issue":"1","key":"pone.0282883.ref050","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1111\/birt.12260","article-title":"The Role of Trust in CenteringPregnancy: Building Interpersonal Trust Relationships in Group-Based Prenatal Care in The Netherlands.","volume":"44","author":"L Kweekel","year":"2017","journal-title":"Birth (Berkeley, Calif)."},{"issue":"1","key":"pone.0282883.ref051","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1186\/s12884-020-03204-3","article-title":"Women\u2019s characteristics and care outcomes of caseload midwifery care in the Netherlands: a retrospective cohort study.","volume":"20","author":"P Offerhaus","year":"2020","journal-title":"BMC Pregnancy and Childbirth"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0282883","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T17:49:00Z","timestamp":1678902540000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0282883"}},"subtitle":[],"editor":[{"given":"Hanna","family":"Landenmark","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,3,15]]},"references-count":51,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,3,15]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0282883","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,15]]}}}