What is normal progress in the first stage of labour? A vignette study of similarities and differences between midwives and obstetricians

A. Romijn*, A. M. M. Muijtjens, M. C. de Bruijne, H. H. L. M. Donkers, C. Wagner, C. J. M. de Groot, P. W. Teunissen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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. Design: factorial survey. Setting: 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. Participants: respondents consisted of primary-care midwives (N=69), obstetricians (N=47) and hospital based midwives, known as clinical midwives (N=31). Measurements: 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. Findings: 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 inter professional alignment of clinical assessments, for instance through interprofessional discussions and a review of professional guidelines, might help to improve collaborative care.
Original languageEnglish
Pages (from-to)104-109
JournalMidwifery
Volume41
DOIs
Publication statusPublished - Oct 2016

Keywords

  • First stage of labour
  • Progression
  • Referral
  • Vignette
  • Decision-making

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