Risk indicators for referral during labor from community midwife to gynecologist: a prospective cohort study

Ewoud Schuit, Chantal W P M Hukkelhoven, Birgit Y. van der Goes, Ilanit Overbeeke, Karel G M Moons, Ben W J Mol, Rolf H H Groenwold, Anneke Kwee

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2 Citations (Scopus)

Abstract

Objective: To identify risk indicators for referral during labor from community midwife to a gynecologist in a prospective cohort of women with a singleton term pregnancy, starting labor with a community midwife between 2000 and 2007, registered in the Dutch national perinatal registry. Main outcome measures: Referral from community midwife to a gynecologist during labor, because of fetal distress, failure to progress in second stage of labor, meconium stained amniotic fluid, failure to progress in first stage of labor, wish for pain relief, a combination of other less urgent reasons or no referral (reference). Results: A total of 241 595 (32%) were referred from community midwife to a gynecologist during labor, because of fetal distress (FD;5%), failure to progress in second stage of labor (FTP2;14%), meconium stained amniotic fluid (MSAF;24%), failure to progress in first stage of labor (FTP1;17%), wish for pain relief (WFPR;7%) or a combination of other less urgent reasons, for example, malpresentation (e.g. breech) or other nonspecified problems (OTHER;33%). The strongest overall risk indicators were gestational age (lower risk of referral because of FD, FTP2, MSAF, FTP1 and WFPR and a higher risk of referral because of OTHER at a gestational age between 37+0 and 37+ 6 weeks, and higher risks of referral for all reasons at a gestational age ≥41+ 0 when compared to a gestational age between 38 + 0 and 40 + 6 weeks and no referral), the intended place of delivery (higher risk of all types of referral compared to no referral when the intended place of delivery was either at a midwife-led birth center or a hospital instead of at home) and birth history (higher risk of all types of referral compared to no referral when women had a history of instrumental vaginal delivery or when they were nulliparous instead of being multiparous without a history of an instrument vaginal delivery). Risk indicators associated with specific reasons of referral were maternal age, ethnicity, degree of urbanization, social economic status, neonatal gender and birth weight. Conclusions: Among low-risk pregnant women, a referral during labor is associated with readily available risk indicators. These risk indicators may be used to increase referral risk awareness and to counsel women for the intended place to start labor.

Original languageEnglish
Pages (from-to)3304-3311
Number of pages8
JournalJournal of Maternal-Fetal and Neonatal Medicine
Volume29
Issue number20
DOIs
Publication statusPublished - 17 Oct 2016

Keywords

  • Primary care
  • referral during labor
  • risk indicators
  • singleton
  • term pregnancy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynaecology

Cite this

Schuit, E., Hukkelhoven, C. W. P. M., van der Goes, B. Y., Overbeeke, I., Moons, K. G. M., Mol, B. W. J., ... Kwee, A. (2016). Risk indicators for referral during labor from community midwife to gynecologist: a prospective cohort study. Journal of Maternal-Fetal and Neonatal Medicine, 29(20), 3304-3311. https://doi.org/10.3109/14767058.2015.1124080