Organisation of emergency transfer in maternity care in the Netherlands.

OBJECTIVE: to gain more insight in the perceptions and experiences of care providers and clients with the organisation of emergency transfer in maternity care, with regard to transportation, responsibilities and communication between caregivers.
BACKGROUND: in the Netherlands a woman with an uncomplicated pregnancy can choose to give birth at home, assisted by her own midwife. However, when complications arise, she needs to be referred to a hospital. In case of an emergency this referral must be effectuated quickly, often with ambulance support.
DESIGN: a mixed methods' study consisting of semi-structured interviews and surveys.
METHODS: qualitative data of the current organisation of emergency transfer in maternity care, including experiences of caregivers were collected through 21 semi-structured interviews. On the basis of the qualitative data questionnaires for a survey were developed. These questionnaires were sent to 181 caregiver organisations and an unknown number of clients. The response among caregivers was 108 (60%), the response among clients was 42.
FINDINGS: the overall result from the interviews as well as from the questionnaires is that at the personal level cooperation is often adequate, but mostly informal. Care providers from different professions explained in the study that in emergency situations they usually know how to find each other but they are not always aware of existing agreements or protocols, are unsure of each other's competencies and do not always know what to expect from other care providers. Looking back at their experiences the majority of the clients responded that they were taken very good care of at the hospital. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE: because transfer of care from one care provider to another during labour or birth is not unusual in the Dutch maternity care system it is necessary for care providers involved in this transfer to know and trust each other, to be able to give an adequate reaction when needed. Recommendations given are to devise a protocol for midwives when calling an ambulance dispatch centre, to improve the knowledge about each other, for instance by providing combined courses for emergency obstetrics, preferably at the regional level, so people who actually may work together can train together, and to improve the referral process from midwife to obstetrician.