161 The contribution of regional protocols on practice variation in induction of labor was considered necessary by the primary care midwife. Thirdly, additional care options were described compared to care described in the national guidelines. Examples in MCNs with a low percentage of IOLs were the option of artificial rupture of membranes in midwife-led care to induce labor and the option of antenatal cardiotocography for fetal assessment in midwife-led care in cases of reduced fetal movements instead of cardiotocography in obstetrician-led care. These options create opportunities for more continuity of care and potentially fewer referrals for IOL in obstetrician-led care. Extra diagnostic tests such as ultrasound or oral glucose testing were described as additional options in MCNs with a higher percentage of IOL, potentially leading to more situations in which IOL is recommended. Self-developed recommendations had mostly no references to scientific literature and were not explained with considerations of care providers. 7
RkJQdWJsaXNoZXIy MTk4NDMw