title: Intrapartum referral from primary to secondary care in the Netherlands: a retrospective cohort study on management of labor and outcomes.
abstract: BACKGROUND
  In the Dutch maternity care system, primary care midwives provide care to low-risk women and refer to obstetricians if risks or complications occur. We examined reasons for referral, management of labor, and maternal and neonatal outcomes among women who were referred during labor.
  
  
  METHODS
  In a retrospective cohort study, descriptive analyses were performed on data obtained from patient records. Six purposively chosen hospitals in The Netherlands participated in the study from June 2011 to February 2012. The study population included 600 pregnant women who were referred during labor from primary to secondary care.
  
  
  METHODS
  Reasons for referral, interventions after referral, mode of delivery, and maternal and neonatal outcomes.
  
  
  RESULTS
  Of women who were referred during labor, three out of four women were referred for moderate risk indications: request for pain relief (30.5%), meconium-stained liquor (25.3%), failure to progress during first stage of labor (14.0%), and prolonged ruptured membranes without contractions (12.5%). Of all women, 65.7 percent had a spontaneous vaginal delivery and 59.7 percent received some kind of pain relief. Acute referral, meaning fetal distress, occurred in 5.5 percent. Of the newborns, 2.7 percent had an Apgar score of 7 or less after 5 minutes and 1.2 percent had an umbilical cord pH < 7.05. Postpartum complications occurred among 11.0 percent of women.
  
  
  CONCLUSIONS
  Women who are referred during labor have a high probability of spontaneous vaginal delivery. To improve continuity of care and satisfaction for this group of women, management of labor could be continued by trained primary care midwives.
authors.affiliation: Department of Midwifery Science, AVAG and the EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Hilde
authors.initials: H
authors.lastname: Perdok
authors.affiliation: Royal Dutch Organisation of Midwives, Utrecht, The Netherlands.
authors.forename: Suze
authors.initials: S
authors.lastname: Jans
authors.affiliation: Department of Midwifery Science, AVAG and the EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.|Maxima Medical Centre, Veldhoven, The Netherlands.
authors.forename: Corine
authors.initials: C
authors.lastname: Verhoeven
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Medical Centre Nijmegen, The Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: van Dillen
authors.affiliation: Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia.
authors.forename: Ben Willem
authors.initials: BW
authors.lastname: Mol
authors.affiliation: Department of Midwifery Science, AVAG and the EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Ank
authors.initials: A
authors.lastname: de Jonge
mesh_terms: D000328:Adult; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008880:Midwifery / Q000379:methods / Q000706:statistics & numerical data; D009426:Netherlands / Q000453:epidemiology; D007744:Obstetric Labor Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D017063:Outcome Assessment, Health Care; D036801:Parturition; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies; D063127:Secondary Health Care / Q000379:methods / Q000706:statistics & numerical data
keywords: care during labor; midwifery; obstetrics; referrals