M. Fleuren et al., ADHERENCE BY MIDWIVES TO THE DUTCH NATIONAL GUIDELINES ON THREATENED MISCARRIAGE IN GENERAL-PRACTICE - A PROSPECTIVE-STUDY, Quality in health care, 6(2), 1997, pp. 69-74
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.