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Table 3 Quality indicators for low-risk labor care provided primarily by midwives in Japan

From: Development of quality indicators for low-risk labor care provided by midwives using a RAND-modified Delphi method

No. Indicator Rating result Median Agreement (%)b
1. Primipara who has enrolled in a childbirth class about antenatal care and delivery by 36 weeks gestation adopted 8 8 (72.7%)
2. Discussed a birth plana added and adopted 9 11 (100%)
3. Initial assessment of labor risk at admission adopted 7 10 (90.9%)
4. Assessment during first stage labor adopted 8 8 (72.7%)
5. Assessment during second stage labor adopted 9 10 (90.9%)
6. Women with a term, singleton infant in vertex position delivered by Cesarean section adopted 8 10 (90.9%)
7. Women with a term, singleton infant in vertex position delivered by Vaginal delivery adopted 9 11 (100%)
8. Women with a term, singleton infant in vertex position delivered by Instrument delivery adopted 9 11 (100%)
9. Women with a term, singleton infant in vertex position delivered by labor inductiona modified and adopted 8 9 (81.8%)
10. Term infant with Apgar score less than 7 at five minutes after birth adopted 9 9 (81.8%)
11. Living infant with birth injuries adopted 7 9 (81.8%)
12. Respiratory support: Resuscitation for asphyxiated term neonate with low oxygen concentrations and oxygen saturation measured by pulse oximetry immediately after birtha added and adopted 8 10 (90.9%)
13. Women with perineal tear and no episiotomy adopted 9 11 (100%)
14. Second degree perineal lacerationa added and adopted 8 9 (81.8%)
15. Third or fourth degree perineal laceration adopted 8 11 (100%)
16. Postpartum hemorrhage more than 500 g within 2 h of birth adopted 8 10 (90.9%)
17. Infant admission to pediatrics department within a week after birth (excludes those with congenital anomalies) adopted 8 9 (81.8%)
18. Infants that were fed only breast milk at the time of discharge from the hospital adopted 8 11 (100%)
19. Peer review of severe adverse events with medical staff adopted 8 9 (81.8%)
20. Woman switched to receive care provided primarily by obstetricians from midwifery ward adopted 8 11 (100%)
21. Mother received cessation counseling intervention (including guidance on smoking cessation) if identified as either a tobacco user or passive smoker adopted 7 6 (54.5%)
22. Infant administered vitamin K three times by one month after birth adopted 9 11 (100%)
23. Infants who had been fed only breast milk at the time of the health examination for children of 1 month of agea added and adopted 9 11 (100%)
24. Women with second degree perineal laceration, not due to instrument delivery not adopted 1 4 (36.4%)
25. Women that unintentionally retained foreign objects during labor and delivery not adopted 5 4 (36.4%)
26. Neonatal bloodstream infections within 48 h of birth not adopted 5 2 (18.2%)
27. Medication error made in non-recommended abbreviations, symbols or dose designations used in medical prescriptions not adopted 1 0 (0%)
28. Women with complex social factors who were offered additional support and information on public resources not adopted 2 1 (9.1%)
29. Women that received antenatal or postnatal guidance regarding body weight and physical activity not adopted 6 5 (45.4%)
  1. These indicators denote the frequency with which care was provided and recorded for women admitted to an in-hospital midwifery ward
  2. aThese indicators were advanced in Step 4 and rated in Step 5
  3. bAgreement (%) indicates the proportion of members who gave ratings of 7–9 points to adopt a candidate quality indicator