Dutch insurers pay midwives not to refer breech presentations to hospital

Gynaecologists in the Netherlands fear that women could have more complications in childbirth because of a contract between health insurers and midwives that offers financial incentives to reduce expensive referrals to hospital.

The contract promotes the use, in primary care, of external cephalic version. If unsuccessful then women could be referred to hospital. This approach aims to reverse a trend towards caesarean sections.

The Dutch Association for Obstetrics and Gynaecology says that external cephalic version should be offered by hospital gynaecologists in a safer clinical environment, however. It fears that offering financial incentives to keep …