Reasons For Hospital Transfers For Women In Labour

Main Category: Pregnancy / Obstetrics
Also Included In: Nursing / Midwifery
Article Date: 04 Apr 2008 - 3:00 PDT

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The Netherlands is often held up as the beacon for excellent midwifery services. Obstetric intervention during births is low and the homebirth rate is 30%, significantly higher in comparison to other European countries. New research to be published in BJOG: An International Journal of Obstetrics and Gynaecology, examines the incidence of home births referred to hospital and the reasons for transfer.

Referrals can occur during labour or in the postpartum period. Other Dutch research conducted suggests that the rate of referrals have been increasing slowly but steadily in recent years.

In this study, the referrals of 280,097 low-risk women, under the care of midwives at the start of labour were examined over the period 2001 - 2003.

Researchers found that 68.1% of the women in the study were not referred, 3.6% were referred urgently and 28.3% were referred without urgency. Of the group of women who were referred, 11.2% were found to have been urgent. For women who had a planned hospital birth, the numbers being referred to obstetric care were higher than those who had planned a delivery at home.

Women who were first-time mothers, from ethnic backgrounds and those living in urbanised areas had a higher chance of being referred. Fetal distress was a reason for 50.2% of the urgent referrals. Postpartum haemorrhage made up 33% and neonatal factors accounted for 9.9% of urgent referrals.

Researchers note that impediments to referrals during home delivery include transfer times from home to hospital, and the physical discomfort and stress experienced by the mother during transfer.

Dr Mary-Ann Anelink, from the Netherlands Organisation for Applied Scientific Research in Leiden, who led the study said "The Dutch birth care system is unique in the world. Independent, well-trained midwives deliver a large proportion of the care to pregnant and labouring women. Approximately 55% of women in the Netherlands start labour under the care of a midwife.

"The study shows that risk-selection is a crucial element of the Dutch obstetric system which has to be continued into the postpartum period. This system, which distinguishes between women with a low-risk of pathology and those with a high-risk (and the division of care roles within the maternity setting) needs clear agreements and strict protocols for collaboration between midwives and obstetricians. These are important practices which have to be embedded into maternity services."

Professor Philip Steer, BJOG Editor-in-Chief, said, "This study shows that women who planned to have a home birth were referred to obstetricians less frequently than those with a planned hospital delivery.

"The study has also observed that most urgent referrals occur during the later stages of labour or if the newborn is poorly.

"The evidence shows that the Dutch system of risk selection works well provided adequate resources and support mechanisms are in place to deal with all contingencies."

Notes

BJOG: An International Journal of Obstetrics and Gynaecology is owned by the Royal College of Obstetricians and Gynaecologists (RCOG) but is editorially independent and published monthly by Blackwell Publishing. The journal features original, peer-reviewed, high-quality medical research in all areas of obstetrics and gynaecology worldwide. Please quote 'BJOG' or 'BJOG: An International Journal of Obstetrics and Gynaecology' when referring to the journal.

Reference

Evaluation of 280 000 cases in Dutch midwifery practices: a descriptive study.
Amelink-Verburg M, Verloove-Vanhorick S, Hakkenberg R, Veldhuijzen I, Bennebroek Gravenhorst J, Buitendijk S.
BJOG 2008;115:570-578.

Royal College of Obstetricians and Gynaecologists