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Birth. 2014 Jun;41(2):195-205. doi: 10.1111/birt.12102. Epub 2014 Apr 6.

Opinions of maternity care professionals about integration of care during labor for "moderate risk" indications: a Delphi study in the Netherlands.

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Department of Midwifery Science, AVAG and the EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.



The percentage of referrals during labor from primary midwife-led care to obstetrician-led care has increased over the past years in The Netherlands. Most women are referred for indications with a moderate increase in risk and are looked after by clinical midwives. This study aims to provide insight into the opinions of maternity care professionals about integration of care and involvement of primary care midwives in the intrapartum care of women with "moderate risk" factors.


A Delphi study consisting of three rounds was conducted. A purposively selected heterogenic panel of 50 professionals, including obstetricians, primary care midwives, clinical midwives, and obstetric nurses, answered questions anonymously.


Although primary care midwives would like to expand their responsibilities and tasks with respect to "moderate risk" indications, consensus among panel members was only reached concerning prolonged rupture of membranes for which the primary care midwife could remain the caregiver.


This study shows that most participants support more integration of care during labor. The lack of consensus among Dutch maternity care professionals with regard to the distribution of responsibilities and tasks for "moderate risk" indications is a challenge. Further studies should explore how to deal with differences in opinions among professionals when integrating maternity care systems.


care during labor; health care integration; health manpower; midwifery; obstetrics

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