The cesarean section rate has been rising over the past decades without significantly improving maternal and neonatal outcomes. Management of labor has a profound influence on the risk for cesarean delivery, in particular monitoring of progress in the first stage of labor, and how failure to progress has been diagnosed. In the Netherlands, two different policies regarding management of the first stage of labor are being used by primary care midwives. Some primary care midwives follow the recommendations of the KNOV- guideline “Niet-vorderende ontsluiting” (NVO-guideline) whereas other midwives follow the policy of pro-active support of labor (PSOL).
- To investigate the referral rate from primary midwife-led care to obstetrician-led (secondary) care for the indication failure to progress in the first stage of labor, and to investigate the cesarean section rate among low risk women with the diagnosis “failure to progress during first stage of labor”. Second objective is to investigate whether this rate has changed during the last decade.
- To gain insight in the types of management of the first stage of labor of primary care midwives by comparing two types of management of the first stage of labor: management according to the NVO-guideline and management according to PSOL, on the number of referrals to secondary care for failure to progress during the first stage of labor.
This research will contribute to knowledge on factors associated with the management of the first stage of labor. Given the fact that management of labor has an impact on the cesarean section rate, this is of importance not only for midwives and obstetricians, but also for pregnant women.