Evaluation of 280 000 cases in Dutch midwifery practices: A descriptive study

  • Amelink-Verburg M
  • Verloove-Vanhorick S
  • Hakkenberg R
 et al. 
  • 77

    Readers

    Mendeley users who have this article in their library.
  • 75

    Citations

    Citations of this article.

Abstract

Objective To assess the nature and outcome of intrapartum referrals from primary to secondary care within the Dutch obstetric system. Design Descriptive study. Setting Dutch midwifery database (LVR1), covering 95{%} of all midwifery care and 80{%} of all Dutch pregnancies (2001–03). Population Low-risk women (280 097) under exclusive care of a primary level midwife at the start of labour either with intention to deliver at home or with a personal preference to deliver in hospital under care of a primary level midwife. Methods Women were classified into three categories (no referral, urgent referral and referral without urgency) and were related to maternal characteristics and to neonatal outcomes. Main outcome measures Distribution of referral categories, main reasons for urgent referral, Apgar score at 5 minutes, perinatal death within 24 hours and referral to a paediatrician within 24 hours. Results In our study, 68.1{%} of the women completed childbirth under exclusive care of a midwife, 3.6{%} were referred on an urgency basis and 28.3{%} were referred without urgency. Of all referrals, 11.2{%} were on an urgency basis. The main reasons for urgent referrals were fetal distress and postpartum haemorrhage. The nonurgent referrals predominantly took place during the first stage of labour (73.6{%} of all referrals). Women who had planned a home delivery were referred less frequently than women who had planned a hospital delivery: 29.3 and 37.2{%}, respectively (P < 0.001).On average, the mean Apgar score at 5 minutes was high (9.72{%}) and the peripartum neonatal mortality was low (0.05{%}) in the total study group. No maternal deaths occurred. Adverse neonatal outcomes occurred most frequently in the urgent referral group, followed by the group of referrals without urgency and the nonreferred group. Conclusions Risk selection is a crucial element of the Dutch obstetric system and continues into the postpartum period. The system results in a relatively small percentage of intrapartum urgent referrals and in overall satisfactory neonatal outcomes in deliveries led by primary level midwives.

Author-supplied keywords

  • Midwifery
  • Neonatal outcome
  • Perinatal registry
  • Planned home birth
  • Referral

Get free article suggestions today

Mendeley saves you time finding and organizing research

Sign up here
Already have an account ?Sign in

Find this document

Authors

  • M. P. Amelink-Verburg

  • S. P. Verloove-Vanhorick

  • R. M.A. Hakkenberg

  • I. M.E. Veldhuijzen

  • J. Bennebroek Gravenhorst

  • S. E. Buitendijk

Cite this document

Choose a citation style from the tabs below

Save time finding and organizing research with Mendeley

Sign up for free