P. Konstantiniuk, I. Kern, A. Giuliani, F. Kainer
The midwife factor in obstetric procedures and neonatal outcome
Aims. In the face of major tendency towards midwiferyled-
care it was our purpose to investigate the extent of
the influence of the midwife on the rates of obstetric procedures
and perinatal outcome.
Methods. 5384 consecutive deliveries at the Department
of Obstetrics and Gynecology, University of Graz, were
enrolled in the study. The following data were collected:
mode of delivery, pH of umbilical artery, Apgar score.
Firstly, data were investigated for interindividual differences
and, secondly, for relationship with age of the midwife
as a measure of experience.
Results. Interindividual differences were significant for
episiotomy rates (minimum: 31.6%; maximum 76.9%;
p<0.001), forceps rates (minimum: 1.7%; maximum
11.1%;p=0.002) and pH of umbilical arteries (minimum:
7.21; maximum: 7.28; p=0.001) but not for cesarean section
rates and Apgar scores.
Linear regression analysis was significant between age of
midwives and pH of umbilical arteries (p<0.001;
r=0.055) and for one-minute Apgar score (p=0.009;
r=0.050) but not for episiotomy rates, cesarean section
rates, forceps rates and five-minutes Apgar score.
Conclusions. There are large interindividual differences
in obstetric intervention rates which cannot be explained
by the midwives' age. Provision of health care should be
primarily determined by need and not by the personal
characteristics of the health care provider, thus interindividual
differences should be reduced and more often taken
into account when analyzing any kind of data.
Journal of Perinatal Medicine, Walter de Gruyter
Print ISSN: 1619-3997
Volume: 30, 06/2002
Pages: 242 - 249
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