Variation in referrals to secondary obstetrician-led care among primary midwifery care practices in the Netherlands: a nationwide cohort study

Table 3 Referrals, interventions and birth outcomes in women in primary care, by intrapartum referral rates in practices

	Rate of intrapartum referrals among nulliparous women in midwifery practices (tertiles)
	T1 (low)	T2	T3 (high)	total	χ²p-value
Nulliparous women	n = 35,180	n = 40,021	n = 37,605	n = 112,806
Referral type	%	%	%	%
No dp referral	51.9	42.8	35.2	43.1
Non urgent 1st stage	33.6	42.1	48.0	41.4
Non urgent 2nd stage	7.5	8.9	9.5	8.7
Non urgent, stage unclear	4.3	3.1	3.5	3.6
Urgent	2.7	3.1	3.8	3.2
Obstetric intervention during labour ^#
None	65.4	58.4	51.7	58.4	<.001
Pain relief (no epidural)	12.6	15.7	15.8	14.8
Epidural (1st stage)	11.7	14.0	19.3	15.1
Augmentation	28.6	34.2	39.8	34.3
Mode of birth					<.001
Spontaneous vaginal	77.3	73.5	72.0	74.2
Instrumental vaginal	15.3	18.0	18.8	17.4
Caesarean section	7.3	8.6	9.2	8.4
Morbidity
PPH > 1000 cc	5.3	5.6	6.2	5.7	<.001
Apgar score (5 min) < 7	1.2	1.0	0.9	1.0	.019
Apgar score (5 min) < 4	0.3	0.2	0.2	0.2	.030
Multiparous women	n = 41,273	n = 46,158	n = 42,708	n = 130,139
Referral type	%	%	%	%
No dp referral	82.2	78.8	74.3	78.4
Non urgent 1st stage	13.5	16.6	20.5	16.9
Non urgent 2nd stage	1.3	1.7	1.7	1.6
Non urgent, stage unclear	2.1	1.7	2.1	2.0
Urgent	0.9	1.2	1.4	1.1
Obstetric intervention during labour ^#
None	90.7	89.3	86.4	88.8	<.001
Pain relief (no epidural)	3.6	4.4	5.4	4.5
Epidural (1st stage)	1.4	1.5	2.3	1.7
Augmentation	7.3	8.2	10.2	8.6
Mode of birth					.234
Spontaneous vaginal	97.3	97.2	97.2	97.2
Instrumental vaginal	1.5	1.7	1.6	1.6
Caesarean section	1.2	1.1	1.2	1.2
Morbidity
PPH > 1000 cc	3.3	3.5	3.9	3.6	<.001
Apgar score (5 min) < 7	0.5	0.4	0.4	0.4	.390
Apgar score (5 min) < 4	0.1	0.1	0.1	0.1	.311

Missing values: parity 20, referral type 1; obst. interventions 5; Mode of birth 1,294; PPH 2,374; Apgar score 98.
^#sums up to >100%, more than one intervention possible.

ISSN: 1471-2393