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:maxinium: 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