Table 3.
Referrals, interventions and birth outcomes in women in primary care, by intrapartum referral rates in practices
| Rate of intrapartum referrals among nulliparous women in midwifery practices (tertiles) | |||||
|---|---|---|---|---|---|
| T1 (low) | T2 | T3 (high) | total | χ 2 p-value | |
| Nulliparous women | n = 35,180 | n = 40,021 | n = 37,605 | n = 112,806 | |
| Referral type | % | % | % | % | |
| No dp referral | 51.9 | 42.8 | 35.2 | 43.1 | |
| Non urgent 1st stage | 33.6 | 42.1 | 48.0 | 41.4 | |
| Non urgent 2nd stage | 7.5 | 8.9 | 9.5 | 8.7 | |
| Non urgent, stage unclear | 4.3 | 3.1 | 3.5 | 3.6 | |
| Urgent | 2.7 | 3.1 | 3.8 | 3.2 | |
| Obstetric intervention during labour # | |||||
| None | 65.4 | 58.4 | 51.7 | 58.4 | <.001 |
| Pain relief (no epidural) | 12.6 | 15.7 | 15.8 | 14.8 | |
| Epidural (1st stage) | 11.7 | 14.0 | 19.3 | 15.1 | |
| Augmentation | 28.6 | 34.2 | 39.8 | 34.3 | |
| Mode of birth | <.001 | ||||
| Spontaneous vaginal | 77.3 | 73.5 | 72.0 | 74.2 | |
| Instrumental vaginal | 15.3 | 18.0 | 18.8 | 17.4 | |
| Caesarean section | 7.3 | 8.6 | 9.2 | 8.4 | |
| Morbidity | |||||
| PPH > 1000 cc | 5.3 | 5.6 | 6.2 | 5.7 | <.001 |
| Apgar score (5 min) < 7 | 1.2 | 1.0 | 0.9 | 1.0 | .019 |
| Apgar score (5 min) < 4 | 0.3 | 0.2 | 0.2 | 0.2 | .030 |
| Multiparous women | n = 41,273 | n = 46,158 | n = 42,708 | n = 130,139 | |
| Referral type | % | % | % | % | |
| No dp referral | 82.2 | 78.8 | 74.3 | 78.4 | |
| Non urgent 1st stage | 13.5 | 16.6 | 20.5 | 16.9 | |
| Non urgent 2nd stage | 1.3 | 1.7 | 1.7 | 1.6 | |
| Non urgent, stage unclear | 2.1 | 1.7 | 2.1 | 2.0 | |
| Urgent | 0.9 | 1.2 | 1.4 | 1.1 | |
| Obstetric intervention during labour # | |||||
| None | 90.7 | 89.3 | 86.4 | 88.8 | <.001 |
| Pain relief (no epidural) | 3.6 | 4.4 | 5.4 | 4.5 | |
| Epidural (1st stage) | 1.4 | 1.5 | 2.3 | 1.7 | |
| Augmentation | 7.3 | 8.2 | 10.2 | 8.6 | |
| Mode of birth | .234 | ||||
| Spontaneous vaginal | 97.3 | 97.2 | 97.2 | 97.2 | |
| Instrumental vaginal | 1.5 | 1.7 | 1.6 | 1.6 | |
| Caesarean section | 1.2 | 1.1 | 1.2 | 1.2 | |
| Morbidity | |||||
| PPH > 1000 cc | 3.3 | 3.5 | 3.9 | 3.6 | <.001 |
| Apgar score (5 min) < 7 | 0.5 | 0.4 | 0.4 | 0.4 | .390 |
| Apgar score (5 min) < 4 | 0.1 | 0.1 | 0.1 | 0.1 | .311 |
Missing values: parity 20, referral type 1; obst. interventions 5; Mode of birth 1,294; PPH 2,374; Apgar score 98.
#sums up to >100%, more than one intervention possible.