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Comment on the Evers et al., (2010). Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands

Abstract:

Midwifery practice in the primary setting has once again come under a critical lens. Evers et al. (2010) published the results of a prospective cohort study which investigated the association between perinatal mortality and maternity caregiver in the BMJ last November. The authors (who included four gynaecologists, a neonatologist, a paediatrician, an epidemiologist, a professor of obstetrics and a secondary care midwife) set out to compare the incidence of perinatal mortality and severe perinatal morbidity between low risk women who were cared for by a midwife in a primary setting and high risk women who received secondary care under the care of an obstetrician. Despite having a high standard of maternity care, the Netherlands have a higher than average perinatal mortality rate (11.4:1000 births) compared with the United Kingdom, Australia and New Zealand who have a perinatal mortality rate of approximately 10:1000 births (PMMRC, 2010). The authors of this study wanted to establish whether the two tiered, primary and secondary maternity care system in the Netherlands was a contributing factor to the higher than average perinatal mortality rate. The main conclusion of the study was that the Dutch obstetric system (which is based on risk selection according to an ‘obstetric indication’ list) possibly contributed to a higher perinatal mortality. This conclusion was based on the findings that delivery related perinatal death was significantly higher for babies of women who had been classed as low risk and were cared for by a midwife in a primary setting compared to women who had been classed as high risk and were cared for by an obstetrician in a secondary setting.

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low and high risk, Netherlands, perinatal morbidity, perinatal mortality, place of birth