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Cohort study
Daytime births are associated with better perinatal outcomes in secondary and tertiary hospitals
  1. Ank de Jonge1,
  2. Jos Twisk2,
  3. Eileen Hutton3
  1. 1Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam
  2. 2Department of Methodology and Applied Biostatistics, Health Science, Faculty of Earth and Life Sciences, VU University Amsterdam
  3. 3Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam and Midwifery Education Program, McMaster University, Hamilton, Canada
  1. Correspondence to: Ank de Jonge
    Van der Boechorststraat 7 1081 BT Amsterdam, The Netherlands; ank.dejonge{at}

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It has been shown that very low birthweight newborns have better outcomes in hospitals with a large neonatal intensive care unit.1 The evidence is less clear on the need for large hospitals for low and medium risk births.2 3 There is concern that the lack of availability of experienced staff and supportive facilities during out-of-office hours in non-tertiary hospitals may lead to an increased rate of adverse neonatal outcomes in evenings, nights and weekends. The objective of this study was to evaluate the role of time of birth, volume of the maternity unit and physician staffing in the performance of maternity units.


Data were used from the Netherlands Perinatal Register over a period of 7 years on singleton births that started in obstetrician-led care. Analyses were conducted separately for births from 22 weeks gestation in tertiary hospitals (N=108 445) and for births from 32 weeks without congenital abnormalities in non-tertiary hospitals (N=655 961). Time of delivery was divided into day-time (8.00–18.00 h), evening-time (18.00–23.59 h) and night-time (0.00–07.59 h). Based on the results of a maternity unit survey a seniority index variable was constructed for non-tertiary hospitals (number of obstetricians and residents in training divided by the total number of obstetricians, residents in training, residents not in training and clinical midwives).

The outcomes were perinatal mortality (intrapartum death or neonatal …

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