Netherlands institute for health services research, PO Box 1568, 3500 BN Utrecht, the Netherlands.
BMC Pregnancy Childbirth. 2010 Dec 9;10:80. doi: 10.1186/1471-2393-10-80.
Most midwives in the Netherlands work in primary care where they are the lead professionals providing care to women with 'normal' or uncomplicated pregnancies, while some midwives work in hospitals ("clinical midwives"). The actual involvement of midwives in maternity care in hospitals is unknown, because in all statistics births in secondary care are registered as births assisted by gynaecologists. The aim of this study is to gain insight in the involvement of midwives with births in secondary care, under supervision of a gynaecologist. This is done using data from the PRN (The Netherlands Perinatal Registry), a voluntary registration of births in the Netherlands. The PRN covers 97% to 99% of all births taking place under responsibility of a gynaecologist.
All births registered in secondary care in the period 1998-2007 (1,102,676, on average 61% of all births) were selected. We analyzed trends in socio-demographic, obstetric and organisational characteristics, associated with the involvement of midwives, using frequency tables and uni- and multivariate logistic regression analyses. As main outcome measure the percentage of births in secondary care with a midwife 'catching' the baby was used.
The proportion of births attended by a midwife in secondary care increased from 8.3% in 1998 to 26.06% in 2007, the largest increase involving spontaneous births of a second or later child, on weekdays during day shifts (8.00-20.00 hr) from younger mothers with a gestational age (almost) at term. After 2002, parallel to the growing numbers of midwives working in hospitals, the percentage of instrumental births decreased.
In 2007 more midwives are assisting with more births in secondary care than in 1998. Hospital-based midwives are primarily involved with uncomplicated births of women with relatively low risk demographical and obstetrical characteristics. However, they are still only involved with half of the less complicated births, indicating that there may be room for more midwives in hospitals to care for women with relatively uncomplicated births. Whether an association exists between the growing involvement of midwives and the decreasing percentage of instrumental births needs further investigation.
荷兰大多数助产士在初级保健机构工作，他们是为“正常”或无并发症妊娠的妇女提供护理的主要专业人员，而一些助产士在医院工作（“临床助产士”）。实际上，助产士在医院参与产科护理的情况尚不清楚，因为在所有统计数据中，二级保健中的分娩都被登记为由妇科医生协助的分娩。这项研究的目的是了解在妇科医生监督下，助产士在二级保健中的参与情况。这是通过使用荷兰围产期登记处（PRN）的数据来完成的，这是荷兰自愿登记的分娩数据。PRN 涵盖了在妇科医生负责下发生的所有分娩的 97%至 99%。
选择 1998 年至 2007 年期间在二级保健机构登记的所有分娩（1,102,676 例，平均占所有分娩的 61%）。我们使用频率表和单变量和多变量逻辑回归分析分析了与助产士参与相关的社会人口统计学、产科和组织特征的趋势。主要观察指标是二级保健中由助产士接生的分娩比例。
在二级保健中由助产士接生的分娩比例从 1998 年的 8.3%增加到 2007 年的 26.06%，最大的增加涉及自发性分娩第二胎或以上、在工作日白天班次（8.00-20.00 小时）、母亲年龄较轻、孕龄（几乎）足月。自 2002 年以来，随着在医院工作的助产士人数不断增加，器械分娩的比例有所下降。
与 1998 年相比，2007 年更多的助产士在二级保健中协助更多的分娩。医院的助产士主要参与低风险的、具有相对较低的人口统计学和产科特征的无并发症妊娠。然而，他们仍然只参与了一半较简单的分娩，这表明医院可能有更多的助产士来照顾相对无并发症的分娩妇女。助产士参与度的增加与器械分娩比例的下降之间是否存在关联，需要进一步研究。
