Referrals for inadequate progress of labour from the midwife obstetric units to the referral hospitals in Cape Town.

Referrals for inadequate progress of labour from the Midwife Obstetric Units (MOUs) to the referral hospitals are responsible for a significant part (approximately 5%) of the workload of these institutions in the Peninsula Maternal and Neonatal Service Region in Cape Town. It is essential for the maintenance of community credibility in the MOUs that patients who develop complications are timely and speedily transferred to the appropriate referral hospital. A sample of 251 patients, who were transferred from the MOUs to the referral hospitals for inadequate progress of labour in the first half of 1992, was analysed. The study showed that midwives in the MOUs had largely adhered to the Departmental referral criteria for that potentially serious complication of labour and had kept excellent records. The referrals, in terms of eventual outcome for the patients and their infants, had been largely appropriate. Several areas of concern were identified. These included incomplete assessment of the stage of labour on admission and inadequate monitoring of the fetal heart in a number of patients. Provision of analgesia in labour was generally inadequate. Ambulance delay was disturbingly common. Recommendations for measures to redress these management deficiencies are presented.