[The audit: a vital but limited measuring instrument].

An audit is an instrument to improve quality of care. It primarily does this by revealing the extent to which medical professionals do not follow existing protocols for patient care. However, it should not replace robust research into new forms of care. Most audits are, in effect, no more than a series of cases of poor outcomes and cannot yield rigorous evidence. In an audit, Van Dillen et al. (2010) report 17 cases of postpartum hemorrhage (PPH) and eclampsia after home births and births started under midwifery care. They show that in 76% of these cases the care by the midwife and/or obstetrician did not follow existing Dutch practice guidelines or consensus. They make recommendations for changes in care, including the introduction of misoprostol in primary care and transfer to hospital if the placenta has not been delivered within half an hour. Although PPH and eclampsia are rare in Dutch primary obstetric care, midwives and obstetricians should make a better effort to adhere to practice guidelines aimed at delivering the best pregnancy and birth care. However, new forms of care should first be researched for effectiveness in lowering maternal morbidity, side effects and costs, before they can be implemented in practice.