Medical indication
A midwife is only authorized to supervise a normal pregnancy and childbirth. She is trained to distinguish when something is still 'normal', or when there is an increased risk and complications (could) occur.
This is called risk selection. When someone has an increased risk or complications occur, a medical indication arises. If there is a medical indication, you will be referred to a gynaecologist. Sometimes only consultation with the gynecologist is necessary (consultation) and some additional examinations are done. If everything appears normal, you will be referred back to the midwife. Sometimes it is necessary for the gynecologist to guide you further. During the pregnancy you will then remain under supervision in the hospital and you will also give birth there (clinical delivery).
Pregnancy
The most common references in pregnancy are:
- An excessively high blood pressure
- Abnormal growth of your baby
- A breech presentation at 37 weeks
- A loaded history, medical problems
- Problems during a previous pregnancy or childbirth
- Feeling less life, reduction of child movements
Birth
The most common referrals during childbirth are:
- The baby has defecated in the amniotic fluid. This is called meconium-containing amniotic fluid.
- A too slow dilation phase, opening your cervix takes too long. This is called a non-progressive dilation (NVO)
- Pressing takes too long. This is also called not progressing the exorcism (NCE).
- The baby's heart tones are not optimal.
- The mother loses too much blood after birth. This is called a fluxus.
In the hospital
In the hospital you will be dealing with gynaecologists, doctors in training to become gynaecologists, medical assistants, interns and nurses. It is important that, even if you have become 'medical' and you fall under the responsibility of the gynaecologist, you talk about your personal wishes and expectations with regard to the pregnancy and childbirth. Even if everything will not always be possible, make it negotiable.
