Measuring the quality of documented care given by Swedish midwives during birth.
OBJECTIVE
To measure the extent to which documented Swedish midwifery care for low-risk labour and birth followed the World Health Organization's (WHO) recommendations for care in normal birth, and to compare midwifery care given to women who's labours were classified as low and high risk.


METHODS
A retrospective examination of midwifery and medical records, 144 from women with low-risk births and 54 from women with high-risk births, for aspects of pregnancy, labour and birth using a validated instrument based on WHO's recommendations.


METHODS
Southern Sweden.


METHODS
Care given in accordance with WHO's four categories of practice and changes in risk group during the birth process.


RESULTS
Care interventions not recommended by WHO, such as routine establishment of an intravenous route, routine amniotomy during the first stage, continuous electronic fetal monitoring and pharmacological methods of pain relief, were widespread in the records. Documented care differed little between the labours of women at low risk and high risk. The midwives at the unit under study did not routinely carry out risk assessment.


CONCLUSIONS
The mode of care was one of readiness for medical intervention. The act of carrying out risk assessments at the time of the woman's admission may affect awareness of the level of care offered to birthing women, and thus help to reduce the number and variety of practices not recommended by WHO.
Kvist
Linda J
LJ
Department of Obstetrics and Gynaecology, Gyn. Mott, Plan 2, Helsingborgs Hospital, 25187 Helsingborg, Sweden. Linda.kvist@med.lu.se
Damiati
Nada
N
Rosenqvist
Johanna
J
Sandin-Bojö
Ann-Kristin
AK
D000328:Adult; D016550:Birthing Centers / Q000458:organization & administration; D036861:Delivery, Obstetric / Q000451:nursing* / Q000592:standards; D005260:Female; D005323:Fetal Monitoring / Q000379:methods; D006801:Humans; D008875:Middle Aged; D008880:Midwifery / Q000379:methods* / Q000592:standards; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D009730:Nursing Assessment / Q000379:methods* / Q000592:standards; D009731:Nursing Audit; D015403:Nursing Evaluation Research; D017063:Outcome Assessment, Health Care; D018743:Perinatal Care / Q000379:methods* / Q000592:standards; D011247:Pregnancy; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D013548:Sweden; D014944:World Health Organization; D055815:Young Adult