Abstract
The second half of the last century saw remarkable changes in the delivery of maternity care services, with the introduction of antibiotics and safe anaesthesia. This was associated with a continued decrease in maternal and perinatal mortality and some were quick to establish a cause-and-effect relationship. However, this was challenged by statisticians and technological developments have also been challenged later by some, though embraced by others. An initial study of midwives’ practice and perception of risk had demonstrated not only a slight link between higher intrapartum intervention rate and higher perception of risk but also an over-pessimistic evaluation of the chances of normal women to progress normally and an over-optimistic risk perception of the outcomes associated with interventions. Known variations in obstetric practice and caesarean section rates suggested that this study might benefit from replication in other European Union member states. The replication of the initial English study aimed at comparing the intrapartum care provided by midwives in the Belgian Flanders and the French regions of Alsace and Lorraine, as well as their intrapartum risk perception for the outcomes of spontaneous labour of nulliparous women suitable for midwifery-led care. A survey by questionnaire was administered to midwives in England, Belgium and France. In England, the midwives were selected on the basis that they worked in maternity units that made their maternity data available centrally on an annual basis. This enabled the analysis of the level of intrapartum interventions for healthy nulliparous women suitable for midwifery-led care and the subsequent comparison of the level of recommended intrapartum care and risk perception by midwives working in maternity units classified as either “lower” or “higher” intrapartum intervention units. The opportunities to replicate the study in Belgium and France were limited to the survey of midwives’ recommended intrapartum care and perception of risk, without the comparison of the actual intrapartum care and outcomes of the maternity units where they practise. All midwives working in the 11 relevant maternity units in England were surveyed. In Belgium, midwives attending the annual Flemish midwives’ conference were surveyed, whereas in France the collaboration of two midwifery schools meant that all midwives involved in intrapartum care in two regions – Alsace and Lorraine – were surveyed. The computerised St Mary’s Maternity Information System data were subjected to systematic data reduction to analyse the data of healthy Caucasian women at term of a healthy pregnancy and in spontaneous labour. The remaining data were then subjected to descriptive statistics to examine the rate of various intrapartum interventions and to establish an intrapartum score that was used to categorise maternity units as either “lower” or “higher” intrapartum intervention units (Mead and Kornbrot, Midwifery 20(1):61–71, 2004). The midwives’ surveys were subjected to descriptive statistical analysis. Major differences in midwifery practice were observed in the three countries: English midwives were more likely to monitor the maternal condition than French and Belgian midwives but less likely to use continuous electronic fetal monitoring, restrict maternal nutrition or recommend epidural analgesia. They were also generally more pessimistic about women’s ability to progress normally in labour. If the variations in methods of delivery observed in England parallel those of France and Belgium, the midwives in all three countries systematically overestimated the benefits of intrapartum intervention and, in particular, epidural analgesia. There are major differences in midwifery practice and in obstetric outcomes in these three countries. It is unlikely that the practices alone can explain the variations in outcomes and, in particular, the differences in caesarean section rates. More research is necessary to examine how the health care systems, perception of risk and attitudes to risk aversion may affect midwifery and obstetric practices and maternity services outcomes.
References
Standing Maternity and Midwifery Advisory Committee CJP (1970) Domiciliary midwifery and maternity bed needs. HMSO, London
Tew M (1995) Safer childbirth? A critical history of maternity care, 2nd edn. Chapman & Hall, London
Boulvain M, Stan C, Irion O (2005) Membrane sweeping for induction of labour. Cochrane Database Syst Rev 2005(1):CD000451
Hofmeyr GJ (2001) Induction of labour with misoprostol. Curr Opin Obstet Gynecol 13(6):577–581
Noren H, Amer-Wahlin I, Hagberg H, Herbst A, Kjellmer I, Marsal K et al (2003) Fetal electrocardiography in labor and neonatal outcome: data from the Swedish randomized controlled trial on intrapartum fetal monitoring. Am J Obstet Gynecol 188(1):183–192
Amer-Wahlin I, Hellsten C, Noren H, Hagberg H, Herbst A, Kjellmer I et al (2001) Cardiotocography only versus cardiotocography plus ST analysis of fetal electrocardiogram for intrapartum fetal monitoring: a Swedish randomised controlled trial. Lancet 358(9281):534–538
Thacker S (1987) The efficacy of intrapartum electronic fetal monitoring. Am J Obstet Gynecol 156:24–30
Le Ray C, Carayol M, Jaquemin S, Mignon A, Cabrol D, Goffinet F (2005) Is epidural analgesia a risk factor for occiput posterior or transverse positions during labour? Eur J Obstet Gynecol Reprod Biol 123(1):22–26
Anim-Somuah M, Smyth R, Howell C (2005) Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev 2005(4):CD000331
Rayburn W, Zhang J (2002) Rising rates of labor induction: present concerns and future strategies. Obstet Gynecol 100(1):164–167
Martin C (1998) Electronic fetal monitoring: a brief summary of its development, problems and prospects. Eur J Obstet Gynecol Reprod Biol 78(2):133–140
Government Statistical Service (2002) NHS maternity statistics, 1998–1999 to 2000–2001, bulletin 2002/11. London, England
Chamberlain G, Wraight A, Steer P (eds) (1993) Pain and its relief in childbirth—the results of a national survey conducted by the National Birthday Trust. Churchill Livingstone, London
Harris J, Chapple J (2000) SMMIS in North Thames (West)—annual maternity figures 1998. Department of Epidemiology and Public Health, Imperial College School of Medicine, London
Macfarlane A, Mugford M (2000) Birth counts, statistics of pregnancy and childbirth, vol 1. The Stationery Office, London
Sleep J, Grant A (1987) West Berkshire perineal management trial: three year follow up. Br Med J (Clin Res Ed) 295(6601):749–751
World Health Organization (1996) Care in normal birth: a practical guide. WHO, Geneva
Salanave B, Bouvier-Colle MH (1996) The likely increase in maternal mortality rates in the United Kingdom and in France until 2005. Paediatr Perinat Epidemiol 10(4):418–422
Schuitemaker NW (1999) Maternal mortality in Europe; present and future. Eur J Obstet Gynecol Reprod Biol 86(2):129–130
Tucker JS, Hall MH, Howie PW, Reid ME, Barbour RS, Florey CdV et al (1996) Should obstetricians see women with normal pregnancies? A multicentre randomised controlled trial of routine antenatal care by general practitioners and midwives compared with shared care led by obstetricians. BMJ 312(7030):554–559
Scheepers HC, Essed GG, Brouns F (1998) Aspects of food and fluid intake during labour. Policies of midwives and obstetricians in The Netherlands. Eur J Obstet Gynecol Reprod Biol 78(1):37–40
Oakley D, Murray M, Murtland T, Hayashi R, Andersen H, Mayes F et al (1996) Comparisons of outcomes of maternity care by obstetricians and certified nurse–midwives. Obstet Gynecol 88(5):823–829
Kamal P, Dixon-Woods M, Kurinczuk JJ, Oppenheimer C, Squire P, Waugh J (2005) Factors influencing repeat caesarean section: qualitative exploratory study of obstetricians’ and midwives’ accounts. BJOG 112(8):1054–1060
Mead M, O’Connor R, Kornbrot D (2000) A comparison of intrapartum care in four maternity units. Br J Midwifery 8(11):709–715
Eddy D (1984) Variations in physician practice: the role of uncertainty. Health Aff 3(2):74–89
Tversky A, Fox C (1995) Weighing risk and uncertainty. Psychol Rev 102(2):269–283
Tversky A, Kahneman D (Psychological Review) Judgment under uncertainty: heuristics and biases. In: Kahneman D, Slovic P, Tversky A (eds) Judgment under uncertainty: heuristics and biases. Cambridge University Press, Cambridge, pp 3–20
Redelmeier DA, Tversky A (1990) Discrepancy between medical decisions for individual patients and for groups. N Engl J Med 322(16):1162–1164
Keljo D, Squires R (1996) Clinical problem-solving: just in time. New Engl J Med 334(1):46–48
McGoogan E (1984) The autopsy and clinical diagnosis. J R Coll Physicians Lond 18(4):240–243
Cochrane A (1979) 1931–1971: a critical review with particular reference to the medical profession. In: Teeling-Smith G (ed) Medicine for the year 2000. Office of Health and Economics, London
Kristensen FB, Andersen KV, Andersen AM, Hermann N, Knudsen VW, Nielsen HK (1995) Physical examinations and laboratory tests in antenatal care visits in Denmark. Do reported practice and current official guidelines concord with results of literature reviews? A nationwide study of the public scheme of shared antenatal care in general practice, centres of midwifery and hospital outpatients’ clinics. Scand J Prim Health Care 13(1):52–58
Lumbiganon P (1998) Appropriate technology: antenatal care. Int J Gynaecol Obstet 63(Suppl 1):S91–S95
Bergsjo P, Villar J (1997) Scientific basis for the content of routine antenatal care. II. Power to eliminate or alleviate adverse newborn outcomes; some special conditions and examinations. Acta Obstet Gynecol Scand 76(1):15–25
CNM Data Group 1996 (1999) Oral intake in labour—trends in midwifery practice. J Nurse-Midwifery 44(2):135–138
WHO (1985) Having a baby in Europe: report on a study. World Health Organization Regional Office for Europe, Copenhagen
Mead MM, Kornbrot D (2004) An intrapartum intervention scoring system for the comparison of maternity units’ intrapartum care of nulliparous women suitable for midwifery-led care. Midwifery 20(1):15–26
Mead MM, Kornbrot D (2004) The influence of maternity units’ intrapartum intervention rates and midwives’ risk perception for women suitable for midwifery-led care. Midwifery 20(1):61–71
European Midwives Liaison Committee (1996) Activities, responsibilities and independence of midwives within the European Union, 1st edn. EMLC
Cammu H, Martens G, De Coen K, Van Mol C, Defoort P (2005) Perinatale activiteiten in Vlaanderen 2004. Studiecentrum voor Perinatale Epidemiologie, Brussels
WHO Euro (2004) European health for all database. WHO, Copenhagen
Scrutton MJL, Metcalfe GA, Lowy C, Seed PT, O’Sullivan G (1999) Eating in labour. A randomised controlled trial assessing the risks and benefits. Anaesthesia 54(4):329–334
Scheepers HCJ, Thans MCJ, Jong PA, Essed GGM, Cessie S, Kanhai HHH (2001) Eating and drinking in labor: the influence of caregiver advice on women’s behavior. Birth 28(2):119–123
Fraser WD, Turcot L, Krauss I, Brisson-Carrol G (2000) Amniotomy for shortening spontaneous labour. Cochrane Database Syst Rev 2000(2):CD000015
Akoury HA, Brodie G, Caddick R, McLaughin VD, Pugh PA (1988) Active management of labor and operative delivery in nulliparous women. Am J Obstet Gynecol 158(2):255–258
O’Driscoll K, Meagher D, Robson M (2003) Active management of labour: the Dublin experience, 4th edn. Mosby, Edinburgh
Emons J, Luiten M (2001) Midwifery in Europe. The Netherlands
European Parliament, European Council (2005) Directive 2005/36/EC of the European Parliament and of the Council on the Recognition of Professional Qualifications. European Union, Brussels
Dunlop W (2006) Training the trainers. In: EBCOG (ed) 19th European congress of obstetrics and gynaecology. EBCOG, Turin
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Mead, M., Bogaerts, A., Reyns, M. et al. Midwives’ perception of intrapartum risk in England, Belgium and France. Eur Clinics Obstet Gynaecol 2, 91–98 (2006). https://doi.org/10.1007/s11296-006-0034-9
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DOI: https://doi.org/10.1007/s11296-006-0034-9