The Wormerveer study; perinatal mortality and non-optimal management in a practice of independent midwives.

In a prospective study in a group of 7980 pregnant women who booked in an independent midwife practice perinatal mortality was studied with the aim to assess non-optimal management. An internally generated audit proved not to be successful because of emotional involvement. A panel of independent experts seemed to be a better instrument to assess the quality of care. In 66 (75%) of all 89 cases complete consensus or near consensus was reached. In this group preventable factors were noticed in 29 cases (44%). In 30 cases (45%) the mortality was judged as inevitable. In 7 cases the information was insufficient. In the 29 cases with preventable factors, 12 cases concerned the skill of the obstetrician, seven cases the skill of the pediatrician, seven cases the skill of the midwife. In two cases the behaviour of the patient and in one case the skill of the general practitioner were blamed. Preventable factors are mainly present in decisions made during the prenatal period by the midwife (or general practitioner) and the obstetrician, and in care during labour and delivery and the postnatal period by the obstetrician and pediatrician. The care of the midwife during labour and delivery had little influence on preventable perinatal mortality. A further decrease of perinatal mortality may be achieved by analysis of the cases and continued education of all workers in perinatal care.

Midwifery in The Netherlands. The Wormerveer study; selection, mode of delivery, perinatal mortality and infant morbidity.

Between 1969 and 1983 a group of 7980 pregnant women, booked consecutively at a practice of freestanding midwives in Wormerveer, the Netherlands, was studied. They gave birth to 8055 children. Perinatal mortality in the total group was low (11.1 per 1000) compared with national figures of 14.5 per 1000 between 1969 and 1983. The highest mortality (51.7 per 1000) was found in the group of 1430 infants born after maternal referral during pregnancy to a specialist obstetrician. The perinatal mortality in the group selected during pregnancy as low-risk cases was very low (2.3 per 1000). The caesarean section rate in the total group was 1.4% and 0.4% in the selected low-risk group. Of the 5985 infants born alive under sole care of a midwife, 3.8% were admitted to hospital. Emergency admission because of birth asphyxia occurred in 0.4%. Convulsions within 48 h of birth at term occurred in seven (0.9 per 1000) in the total group and in five infants born in the selected group (0.8 per 1000). Selection of pregnant women into groups with high and with low risk is possible with the relatively modest means available to the midwife.

[Duration of the second stage and the condition of the neonate in midwife-managed deliveries]. / Uitdrijvingsduur en de toestand van de pasgeborene bij door vroedvrouwen geleide bevallingen.

The correlation between the duration of the second stage on the one hand, and arterial cord blood pH/neurological score on the other hand was calculated for 71 primi- and 77 multiparae. The pregnant women were selected during pregnancy as low risk cases and under care of midwives at the beginning of labour. The deliveries were attended by a midwife or, after referral during labour/delivery, by an obstetrician. It could not be established that a relatively long second stage substantially deteriorated the condition of the neonate. From the findings obtained it does not appear necessary to change the rules regarding maximal duration of second stage (currently two hours for primi- and one hour for multiparae).