ADHERENCE BY MIDWIVES TO THE DUTCH NATIONAL GUIDELINES ON THREATENED MISCARRIAGE IN GENERAL-PRACTICE - A PROSPECTIVE-STUDY

Objective-To determine the feasibility for midwives to adhere to Dutch national guidelines on threatened miscarriage in general practice. De sign-Prospective recording of appointments by midwives who agreed to a dhere to the guidelines on threatened miscarriage. Interviews with the midwives after they had recorded appointments for one year. Setting-M idwifery practices in The Netherlands. Subjects-56 midwives who agreed to adhere to the guidelines; 43 midwives actually made records from 1 56 clients during a period of 12 months. Main outcome measures Adheren ce to each recommendation and reasons for non-adherence. Results-The r ecommendation that a physical examination should take place on the fir st and also on the follow up appointment was not always adhered to. Re asons for non-adherence were the midwives' criticism of this recommend ation, their lack of knowledge or skills, and the specific client situ ation. Adherence to a follow up appointment after 10 days, a counselli ng consultation after six weeks, and not performing an ultrasound scan was low. Reasons for non-adherence were mainly based on the midwives' criticism of these recommendations and reluctance on the part of the client. Furthermore, many midwives did not give information and instru ctions to the client. It is noteworthy that in 13% of the cases the mi dwife's policy was overridden by the obstetrician taking control of th e situation after the midwife had requested an ultrasound scan. Conclu sions-Those recommendations in the guidelines on threatened miscarriag e that are most often not adhered to should be reviewed. To reduce con flicts about ultrasound scans and referrals, agreement on the policy o n threatened miscarriage should be mutually established between midwiv es and obstetricians.