Objective: to study the outcome of labour and women's perceptions of being referred after onset of labour.
Design: a comparative study carried out between October 1998 and April 1999.
Setting: prospective parents in Stockholm, Sweden are offered a choice of which of the five hospitals in which they want to give birth. In reality, there is a lack of maternity beds in Stockholm to implement this policy and therefore nearly 10% of labouring women are being referred during labour.
Participants: the study population was selected from one of the five hospitals. Included in the study were 266 labouring women, with a 37-42 weeks uncomplicated pregnancy, fetus presenting by the vertex and spontaneous onset of labour. During pregnancy, all the women had chosen the same labour ward where they planned to deliver. However, at the onset of labour half of the women, case group I (n = 133) were referred to another maternity unit due to lack of space in the labour ward. For every referred woman a control woman matched for age, parity and date of delivery was selected, with the same inclusion criteria, except being referred, control group II (n = 133).
Methods: a questionnaire with closed and open questions was posted to the women after birth and used to collect quantitative and qualitative data on the outcome of labour and the women's perceptions of referral during labour.
Findings: routines such as epidural analgesia (EDA) (p<0.002), episiotomies (p<0.015) and morphine/pethidine during labour (p<0.023) were more common in the referred group. The women in the referred group considered to a higher extent that referral during labour had affected their emotional state (p<0.001). Women in both groups had been worried during pregnancy by the thought of having to be referred when labour had started and the referral had caused practical problems, stress and a feeling of not being welcome in the referral labour ward.
Key conclusion and implications for practice: referral during established normal labour may affect labour outcome, and the possibility that they may be referred worries women during pregnancy. Maternity policies and practices should be organised so that caring goals, such as continuity of care and women's' participation in birth planning, can be met.