title: What is normal progress in the first stage of labour? A vignette study of similarities and differences between midwives and obstetricians.
abstract: OBJECTIVE
  intrapartum referrals are high-risk situations. To ensure patient safety, care professionals need to have a shared understanding of a labouring woman's situation. We aimed to gain insight into similarities and differences between midwives and obstetricians in the assessment of a prolonged first stage of labour and the decision to refer a woman to a clinical setting in the Netherlands.
  
  
  METHODS
  factorial survey.
  
  
  METHODS
  in the Netherlands, the main caregivers for women with low risks of pathology are primary-care midwives working in the locality. Approximately half of all women start labour under supervision of primary-care midwives. Roughly 40% of these women are referred to a hospital during labour, where obstetricians take over responsibility. In 2013, the reason for referral for 5161 women (14.1% of all referrals during labour) was a prolonged first stage of labour.
  
  
  METHODS
  respondents consisted of primary-care midwives (N=69), obstetricians (N=47) and hospital based midwives, known as clinical midwives (N=31).
  
  
  METHODS
  each respondent assessed seven hypothetical vignettes. The assessment of a prolonged first stage of labour and the decision to refer a woman to a clinical setting based on this indication were used as outcome measures, rated on a 7-point Likert scale (1=very unlikely to 7=very likely). Data were analysed using a linear multilevel model with a two-level hierarchy.
  
  
  RESULTS
  compared to primary-care midwives, obstetricians were more likely to define a prolonged first stage of labour when progress in cervical dilation was slow (b: 1.11; 95% CI: 0.66 - 1.57). The attributes parity, progress, intensity of uterine contractions and the woman's state of mind, were used by all three groups in the decision to refer a woman to clinical setting based on a prolonged first stage of labour. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE: we found relevant interprofessional differences and similarities in the assessment of a prolonged first stage of labour and consequent referral. Further interprofessional alignment of clinical assessments, for instance through interprofessional discussions and a review of professional guidelines, might help to improve collaborative care.
authors: Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: a.romijn@vumc.nl.
authors: A
authors: A
authors: Romijn MSc
authors: Maastricht University, School of Health Professions Education (SHE), Maastricht, The Netherlands. Electronic address: a.muijtjens@maastrichtuniversity.nl.
authors: A M M
authors: AM
authors: Muijtjens Dr Ir
authors: Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: mc.debruyne@vumc.nl.
authors: M C
authors: MC
authors: de Bruijne Dr
authors: Maastricht University, School of Health Professions Education (SHE), Maastricht, The Netherlands. Electronic address: jeroen.donkers@maastrichtuniversity.nl.
authors: H H L M
authors: HH
authors: Donkers Dr
authors: Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands; NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands. Electronic address: c.wagner@vumc.nl.
authors: C
authors: C
authors: Wagner Prof Dr
authors: Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: cj.degroot@vumc.nl.
authors: C J M
authors: CJ
authors: de Groot Prof Dr
authors: Maastricht University, School of Health Professions Education (SHE), Maastricht, The Netherlands; Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: pw.teunissen@vumc.nl.
authors: P W
authors: PW
authors: Teunissen Dr
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007747:Labor Stage, First / Q000523:psychology*; D008880:Midwifery / Q000592:standards; D009426:Netherlands; D009721:Nurse Midwives / Q000523:psychology*; D009774:Obstetrics / Q000592:standards; D036801:Parturition / Q000523:psychology; D010820:Physicians / Q000523:psychology*; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards; D011795:Surveys and Questionnaires
keywords: Decision-making; First stage of labour; Progression; Referral; Vignette