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Netherlands drops plans to deliver acute obstetric care in 15 minutes

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e2302 (Published 23 March 2012) Cite this as: BMJ 2012;344:e2302
  1. Tony Sheldon
  1. 1Utrecht

A key recommendation for improving the Netherlands’ comparatively poor record on perinatal mortality, guaranteeing acute obstetric care within 15 minutes, has been dropped. Health minister Edith Schippers reported to the Dutch parliament that the proposed childbirth standards were “not attainable in the short term.”

But the professional body for obstetrics and gynaecology disagrees, arguing for a decision now on how to reduce the waiting time for acute care.

In 2010 a report by the steering group on pregnancy and birth, “A Good Beginning” (Een Goed Begin), proposed that acute obstetric care should be available around the clock, seven days a week, within 15 minutes (BMJ 2010;340:c277, doi:10.1136/bmj.c277). The report was prompted by Euro-Peristat studies showing the Netherlands’ perinatal mortality figures compared unfavourably with neighbouring European countries (www.europeristat.com).

Schippers has now written to MPs that many of the proposals for improving obstetric care have been achieved. There is now a college for perinatal care, and cooperation agreements between the different professionals involved in obstetric care.

The proposed standard that acute care, from a gynaecologist or obstetric professional together with supporting staff, should always start within 15 minutes of a potentially life threatening situation has not been universally achieved. Imposing it now, argues Schippers, would cause “substantial problems” and “would not be responsible.” The standard would require an estimated 455 extra gynaecologists, costing €269m (£225m; $357m) a year, and taking between 14 and 23 years to recruit. In the meantime three quarters of hospitals would have to shut their acute obstetric departments, and smaller regional hospitals would suffer, reducing the quality and accessibility of acute care, she argued.

Schippers said, “I certainly don’t want to introduce a standard which a well functioning acute obstetric department cannot meet.”

A recent report by healthcare consultants KPMG Plexus, commissioned jointly by the Dutch associations for obstetrics and gynaecology and for hospitals, concluded that introducing the standards for all 91 hospitals “does not appear to be realistic.” But it offered an alternative option of concentrating acute obstetric care on 62 sites. Then the annual cost drops to €46m.

Jacobus Wijma, chair of the Dutch Society for Obstetrics and Gynaecology, said, “If I want to carry out an emergency procedure I have to wait 30 minutes before starting. That is too long.”

He believed concentrating acute obstetric care in 62 hospitals would retain accessibility, allowing patients to reach hospitals within the national maximum agreed time limit of 45 minutes, and would reduce the overall time for treatment. A regional solution based on the 11 perinatal care centres could achieve the 15 minute standard within five to 10 years.

Wijma said, “We don’t say this could happen tomorrow but you must make a choice once in your life. Once you postpone the choice by one year then you have another year before you see the results.”

The latest figures show perinatal mortality rates for full term babies fell by 39% from 2001 to 2010, to 2.3 per 1000, and those for babies born after 22 weeks fell by 23% from 2001 to 2008, to 9.4 per 1000 (www.perinataleaudit.nl).

Notes

Cite this as: BMJ 2012;344:e2302

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