Haemorrhage after home birth: audit of decision making and referral. Part 2: Results and discussion.

This descriptive study aims to identify substandard care (SSC) in PPH after home birth in the Netherlands. Sixty seven cases of postpartum haemorrhage (PPH) reported by community-based midwives were collected. After applying selection criteria, seven cases were submitted to audit. The audit panel consisted of 12 midwives (of whom seven contributed a case), 10 obstetricians, an educational expert and an ambulance paramedic. First, an individual assessment was performed by all members. Subsequently, at a plenary audit meeting, SSC factors were determined and assigned incidental, minor or major status. Major SSC was identified in two out of seven cases. We conclude that communication between different healthcare providers should be optimised and a proactive attitude taken to select women who plan to give birth at home, taking into account the possibility of timely referral in case of PPH or retained placenta. National multidisciplinary guidelines on managing obstetric haemorrhage in home birth are urgently needed.