Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven, Netherlands.
PLoS One. 2023 Mar 15;18(3):e0282883. doi: 10.1371/journal.pone.0282883. eCollection 2023.
In the Netherlands, maternity care is divided into midwife-led care (for low-risk women) and obstetrician-led care (for high-risk women). Referrals from midwife-led to obstetrician-led care have increased over the past decade. The majority of women are referred during their pregnancy or labour. Referrals are based on a continuous risk assessment of the health and characteristics of mother and child, yet referral for non-medical factors and characteristics remain unclear. This study investigated which maternal characteristics are associated with women's referral from midwife-led to obstetrician-led care.
A retrospective cohort study in one midwife-led care practice in the Netherlands included 1096 low-risk women during January 2015-17. The primary outcomes were referral from midwife-led to obstetrician-led care in (1) the antepartum period and (2) the intrapartum period. In total, 11 maternal characteristics were identified. Logistic regression models of referral in each period were fitted and stratified by parity.
In the antepartum period, referral among nulliparous women was associated with an older maternal age (aOR, 1.07; 95%CI, 1.05-1.09), being underweight (0.45; 0.31-0.64), overweight (2.29; 1.91-2.74), or obese (2.65; 2.06-3.42), a preconception period >1 year (1.34; 1.07-1.66), medium education level (0.76; 0.58-1.00), deprivation (1.87; 1.54-2.26), and sexual abuse (1.44; 1.14-1.82). Among multiparous women, a referral was associated with being underweight (0.40; 0.26-0.60), obese (1.61; 1.30-1.98), a preconception period >1 year (1.71; 1.27-2.28), employment (1.38; 1.19-1.61), deprivation (1.23; 1.03-1.46), highest education level (0.63; 0.51-0.80), psychological problems (1.24; 1.06-1.44), and one or multiple consultations with an obstetrician (0.68; 0.58-0.80 and 0.64; 0.54-0.76, respectively). In the intrapartum period, referral among nulliparous women was associated with an older maternal age (1.02; 1.00-1.05), being underweight (1.67; 1.15-2.42), a preconception period >1 year (0.42; 0.31-0.57), medium or high level of education (2.09; 1.49-2.91 or 1.56; 1.10-2.22, respectively), sexual abuse (0.46; 0.33-0.63), and multiple consultations with an obstetrician (1.49; 1.15-1.94). Among multiparous women, referral was associated with an older maternal age (1.02; 1.00-1.04), being overweight (0.65; 0.51-0.83), a preconception period >1 year (0.33; 0.17-0.65), non-Dutch ethnicity (1.98; 1.61-2.45), smoking (0.75; 0.57-0.97), sexual abuse (1.49; 1.09-2.02), and one or multiple consultations with an obstetrician (1.34; 1.06-1.70 and 2.09; 1.63-2.69, respectively).
This exploratory study showed that several non-medical maternal characteristics of low-risk pregnant women are associated with referral from midwife-led to obstetrician-led care, and how these differ by parity and partum period.
在荷兰，产妇护理分为助产士主导的护理（针对低风险女性）和产科医生主导的护理（针对高风险女性）。过去十年中，从中助产士主导的护理向产科医生主导的护理的转诊有所增加。大多数女性在怀孕期间或分娩时被转诊。转诊是基于对母婴健康和特征的连续风险评估，但非医疗因素和特征的转诊仍不清楚。本研究调查了哪些产妇特征与低风险孕妇从中助产士主导的护理向产科医生主导的护理的转诊有关。
对荷兰一家助产士主导的护理机构 2015-17 年期间的 1096 名低风险孕妇进行回顾性队列研究。主要结局是（1）产前和（2）产时从中助产士主导的护理向产科医生主导的护理的转诊。共确定了 11 项产妇特征。在每个时期拟合转诊的逻辑回归模型，并按产次分层。
在产前期间，初产妇的转诊与母亲年龄较大（优势比，1.07；95%置信区间，1.05-1.09）、体重过轻（0.45；0.31-0.64）、超重（2.29；1.91-2.74）或肥胖（2.65；2.06-3.42）、孕前时间>1 年（1.34；1.07-1.66）、中等教育水平（0.76；0.58-1.00）、贫困（1.87；1.54-2.26）和性虐待（1.44；1.14-1.82）有关。对于多产妇，转诊与体重过轻（0.40；0.26-0.60）、肥胖（1.61；1.30-1.98）、孕前时间>1 年（1.71；1.27-2.28）、就业（1.38；1.19-1.61）、贫困（1.23；1.03-1.46）、最高教育水平（0.63；0.51-0.80）、心理问题（1.24；1.06-1.44）和一次或多次与产科医生的就诊（0.68；0.58-0.80 和 0.64；0.54-0.76）有关。在产时期间，初产妇的转诊与母亲年龄较大（1.02；1.00-1.05）、体重过轻（1.67；1.15-2.42）、孕前时间>1 年（0.42；0.31-0.57）、中高等教育水平（2.09；1.49-2.91 或 1.56；1.10-2.22）、性虐待（0.46；0.33-0.63）和多次与产科医生的就诊（1.49；1.15-1.94）有关。对于多产妇，转诊与母亲年龄较大（1.02；1.00-1.04）、超重（0.65；0.51-0.83）、孕前时间>1 年（0.33；0.17-0.65）、非荷兰族裔（1.98；1.61-2.45）、吸烟（0.75；0.57-0.97）、性虐待（1.49；1.09-2.02）和一次或多次与产科医生的就诊（1.34；1.06-1.70 和 2.09；1.63-2.69）有关。
这项探索性研究表明，低风险孕妇的一些非医疗产妇特征与从中助产士主导的护理向产科医生主导的护理的转诊有关，以及这些特征如何因产次和分娩期而异。
