title: Haemorrhage after home birth: audit of decision making and referral.
abstract: In the Netherlands, 20 per cent of women give birth at home. In 0.7 per cent, referral to secondary care because of postpartum haemorrhage (PPH) is indicated. Midwives are regularly trained in managing obstetric emergencies. A postgraduate training programme developed for Dutch community-based midwives called 'CAVE' (pre-hospital obstetric emergency course) focuses on the identification and management of obstetric emergencies, including timely and adequate referral to hospital. This descriptive study aims to identify substandard care (SSC) in PPH after home birth in the Netherlands. Sixty seven cases of PPH reported by community-based midwives were collected. After applying selection criteria, seven cases were submitted to audit. The audit panel consisted of 12 midwives (of which seven contributed a case), 10 obstetricians, an educational expert and an ambulance paramedic. First, an individual assessment was performed by all members. Subsequently, at a plenary audit meeting, SSC factors were determined and assigned incidental, minor and major substandard care.
authors.affiliation: Leiden University Medical Centre.
authors.forename: Marrit
authors.initials: M
authors.lastname: Smit
authors.affiliation: Reinier de Graaf Groep.
authors.forename: Anneke
authors.initials: A
authors.lastname: Dijkman
authors.affiliation: TNO research organisation.
authors.forename: Marlies
authors.initials: M
authors.lastname: Rijnders
authors.affiliation: PLATO Faculty of Social and Behavioural Sciences, University of Leiden.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Bustraan
authors.affiliation: University Medical Centre, St Radboud.
authors.forename: Jeroen
authors.initials: J
authors.lastname: van Dillen
authors.affiliation: Leiden University Medical Centre.
authors.forename: Johanna
authors.initials: J
authors.lastname: Middeldorp
authors.forename: Barbara
authors.initials: B
authors.lastname: Havenith
authors.affiliation: Leiden University Medical Centre and EMGO Institute Centre.
authors.forename: Jos
authors.initials: J
authors.lastname: van Roosmalen
mesh_terms: D000328:Adult; D003657:Decision Making; D005260:Female; D006700:Home Childbirth / Q000451:nursing / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D008485:Medical Audit / Q000458:organization & administration*; D008880:Midwifery / Q000458:organization & administration*; D009426:Netherlands; D009723:Nurse-Patient Relations; D010043:Outcome and Process Assessment, Health Care; D018743:Perinatal Care / Q000706:statistics & numerical data*; D006473:Postpartum Hemorrhage / Q000453:epidemiology* / Q000451:nursing; D011247:Pregnancy; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D055815:Young Adult