Neonatal morbidity in deliveries conducted by midwives and gynecologists. A study of the system of obstetric care prevailing in The Netherlands.

The efficacy of the Dutch system of obstetric care was investigated by comparison of the outcomes of two groups of supposedly normal first pregnancies and deliveries that were solely cared for by midwives (n = 85) or by gynecologists (n = 27). The outcome was measured by pH, PCO2, and base deficit in arterial cord blood (early morbidity) and by neurological examination with Prechtl's method (late morbidity). The occurrence of 10 neurologically nonoptimal infants in the midwife group is thought incompatible with the basis philosophy of the Dutch obstetric system, which is that midwives are able to select the normal pregnancies out of the group of women who present for obstetric care and can assist in maintaining the normal state in these selected cases in the course of delivery. The acid-base values were less favorable in the midwife group than in the gynecologist group. Neurological nonoptimality in the midwife group was related to acidosis. The influence of the site of birth (home or hospital--ambulatory) could be virtually ruled out.