BACKGROUND:
A critical safety mechanism in maternity care involves referral and transfer of pregnant, birthing, and postpartum women and babies from primary maternity care to obstetric and neonatal services when required. There is a dearth of research on mechanisms for developing maternity referral guidelines or their impact on care.

OBJECTIVES:
1. Compare maternity referral guidelines of New Zealand and Australia. 2. Investigate how the guidelines were created and the importance of shared ownership. 3. Examine the role of the guidelines in the provision of care, as perceived by the health professionals involved.

METHODS:
A qualitative descriptive design and content analysis was undertaken. Data included three maternity referral guideline documents; two from Australia and one from New Zealand (NZ), and the transcripts of semi-structured interviews of four midwives and two obstetricians involved in developing and implementing the maternity referral guidelines. Ethics approval for this research was granted by Griffith University, Queensland.

RESULTS:
Similarities and key differences in documents were demonstrated. Four key domains were identified from the interviews: 1. Jointly owned maternity referral guidelines are difficult to achieve. 2. They work well in practice and improve maternity care.· 3. They need to fit each country’s context and be regularly updated.· 4. There is concern that they may be used unreasonably in disciplinary actions, to limit women’s care options or deny a woman’s access to personal health insurance.

CONCLUSIONS:
Developing maternity referral guidelines is a complex task requiring gathering of evidence, discussion and collaboration between professional organisations involved in maternity care. When jointly developed they improve safety of maternity care.

KEY MESSAGE:
Maternity referral guidelines are a critical aspect of safe maternity care supporting "One Million More Midwives" in saving lives globally. Interprofessional - guidelines