Midwifery care for "low-risk" pregnant women during labor is associated with high maternal satisfaction. However, low-risk pregnant women are sometimes referred from midwives to obstetricians due to a shift to the "high-risk" status. Recently, cardiotocogram (CTG) is used for standard delivery care in several Japanese maternity care units. Therefore, we retrospectively examined the influence of CTG management on perinatal outcomes among low-risk pregnant women who preferred maternity care from a midwife during labor.
During the study period, from April to September 2008, 247 pregnant women chose midwifery maternity care during labor at Katsushika Red Cross maternity hospital. Of the 247 cases, 113 (45.8%) were referred from midwives to obstetricians. CTG abnormality was the main reason for referral and accounted for approximately 30% of referrals; weak labor pain was also a main reason for referral. Variable deceleration was observed in more than half of the women referred with CTG abnormality. Among the referred cases with CTG abnormality, the rate of spontaneous delivery was lower and the rate of cesarean section was higher than in referred cases without CTG abnormality. Umbilical arterial pH of cases with CTG abnormality was significantly lower than the low-risk group.
Abnormal CTG findings considerably influenced referrals from midwives to obstetricians. Because of the low umbilical arterial pH in the group with CTG abnormality, our decision for operative delivery might have been correct. We conclude that evaluation and improvement of CTG management is needed in order to achieve high maternal satisfaction and safety in perinatal care.