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.