Academie Verloskunde Maastricht

Home or home-like hospital birth for low-risk nulliparae: does it matter?

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Prospective cohort study

The initial part of this study - a comparison between midwife-led home births and midwife-led hospital births - showed that there was a big difference in the number of interventions (assisted deliveries and caesarean sections) between low-risk births that started in midwife-led primary care and low-risk births that started in obstetric-led  secondary care. However, these kinds of studies are not yet conducted prospectively, prompting the researchers to start this multi-centre prospective cohort study.

Start date: 2006
End date: 2016

The study included women without any medical indication for secondary midwifery care and who were pregnant with their first child. We recruited nationwide and followed 500 women in the first line and 250 women in the second line from 16 weeks gestation to six weeks postpartum. Respondents completed two questionnaires during pregnancy and one after childbirth and kept a weekly dairy to indicate how often there was contact with caregivers. Eventually, the respondents’ medical records were used.


To identify differences in interventions and outcomes, but also characteristics, preferences, expectations and experiences among healthy pregenat women in primary care versus secondary care. Partners also are included in the study.


The Dutch obstetric system is unique. Research is paramount to maintain and improve the quality of this system, applying data that are valid to Dutch obstetric care and recommending pathways for improvement. This study will contribute to the scientific quality and the organization of obstetric care in the Netherlands. Results are expected to clarify the nature and number of interventions, outcomes, preferences, expectations and experiences during pregnancy and childbirth.

van Haaren-ten Haken T, Hendrix M, Smits L, Nieuwenhuijze M, Severens J, de Vries R, et al. The influence of preferred place of birth on the course of pregnancy and labor among healthy nulliparous women: a prospective cohort study. BMC Pregnancy & Childbirth. 2015, 15:33

van Haaren-ten Haken T, Pavlova M, Hendrix M, Nieuwenhuijze M, de Vries R, Nijhuis J. Eliciting prefences for key attributes of intrapartum care in The Netherlands. Birth. 2014(41);2:185-194.

van Haaren-ten Haken T, Hendrix M, Nieuwenhuijze M, Budé L, de Vries R, Nijhuis J. Preferred place of birth: Characteristics and motives of low-risk nulliparous women in the Netherlands.
Midwifery. 2012

Hendrix M. Shortpaper: Home or home-like hospital birth for low-risk nulliparae: does it matter? Verpleegkunde - Nederlands Vlaams Tijdschrift voor Verpleegkundigen 2011;26;34

Hendrix M, Pavlova M, Nieuwenhuijze MJ et al. Differences in preferences for obstetric care between nulliparae and their partners in the Netherlands: a discrete-choice experiment. Journal of Psychosomatic Obstetrics & Gynecology 2010;31: 243-251.

Hendrix M, Evers S, Basten M, Nijhuis J, Severens J. Cost analysis of the Dutch obstetric system: low-risk nulliparous women preferring home or short-stay hospital birth - a prospective non-randomised controlled study. BMC Health Services Research 2009;9:211.

Pavlova M, Hendrix M, Nouwens E, Nijhuis J, van Merode G. The choice of obstetric care by low-risk pregnant women in the Netherlands: Implications for policy and management. Health Policy 2009;93:27-34.

Hendrix M, Van Horck M, Moreta D, Nieman F, Nieuwenhuijze M, Severens J, et al. Why women do not accept randomisation for place of birth: feasibility of a RCT in the Netherlands. BJOG 2009;116(4):537-44.

Maassen M, Hendrix M, Van Vugt H, Veersema S, Smits F, Nijhuis J. Operative deliveries in low-risk pregnancies in The Netherlands: primary versus secondary care. Birth 2008;35:277-282.