ELDERLY NULLIPARAE IN MIDWIFERY CARE IN AMSTERDAM

Objective: to compare labour complications, after an uncomplicated pre gnancy, of first births in women 35 years and older with women 20-30 y ears old. Design: an explorative prospective cohort study. Setting: fo ur independent midwives' practices in Amsterdam. Participants: a group of 49 elderly nulliparae was compared with a group of 99 younger null iparae. Measurements and findings: percentage of referrals and reasons for referral during pregnancy and labour, mode of delivery and obstet ric outcome. Key conclusions: no significant differences in referrals were found between the two compared groups, Obstetric outcome was not different between the groups, except for a tower birthweight in the el derly group, A trend is seen for a raised percentage of referrals duri ng labour in the older group, This is almost completely explained by a failure to progress during first and second stages of labour, Related to this was a trend for an increased incidence of caesarean section i n the older group of women. Implications for practice: after selection , the elderly nullipara, under the care of a midwife, does not have an increased risk of fetal distress or other emergency factors compared to the younger nullipara, However, the referral rates during labour, b oth of younger and older women, are high.