Elderly nulliparae in midwifery care in Amsterdam.

OBJECTIVE to compare labour complications, after an uncomplicated pregnancy, of first births in women 35 years and older with women 20-30 years old. DESIGN an explorative prospective cohort study. SETTING four independent midwives' practices in Amsterdam. PARTICIPANTS a group of 49 elderly nulliparae was compared with a group of 99 younger nulliparae. MEASUREMENTS AND FINDINGS percentage of referrals and reasons for referral during pregnancy and labour, mode of delivery and obstetric outcome. KEY CONCLUSIONS no significant differences in referrals were found between the two compared groups. Obstetric-outcome was not different between the groups, except for a lower birthweight in the elderly group. A trend is seen for a raised percentage of referrals during labour in the older group. This is almost completely explained by a failure to progress during first and second stages of labour. Related to this was a trend for an increased incidence of caesarean section in the older group of women. IMPLICATIONS FOR PRACTICE after selection, the elderly nullipara, under the care of a midwife, does not have an increased risk of fetal distress or other emergency factors compared to the younger nullipara. However, the referral rates during labour, both of younger and older women, are high.