<![CDATA[Basic Emergency Obstetric and Neonatal Services (PONED) provide emergency care for obstetric and neonatal conditions, including hypertensive disorders during pregnancy, shoulder dystocia, vacuum-assisted delivery, postpartum hemorrhage, puerperal infection, and respiratory disorders and seizures in newborns. Based on data from the Rokan Hulu District Health Office in 2024, there were 273 cases (50.83%) of high-risk maternal referrals and 48 cases (47.52%) of high-risk neonatal referrals originating from PONED health centers. This study aimed to identify the factors influencing the referral behavior of village midwives in obstetric and neonatal emergency cases and the appropriateness of referral indications to PONED Health Centers. This study employed a qualitative approach with a case study design. Informants were selected using purposive and snowball sampling techniques until data saturation was achieved. Data were collected through in-depth interviews, observations, and document review, and analyzed using thematic analysis. A total of eight informants participated in the study, consisting of one key informant (a PONED team member), five primary informants (village midwives), and two additional informants (the Head of the PONED Health Center and the Head of the Public Health Division at the District Health Office). The findings showed that the referral behavior of village midwives in obstetric and neonatal emergency cases was influenced by educational level, age, and geographical conditions. In addition, mentoring and supervision of village midwives, as well as quality assurance and supervision of PONED team services, contributed to improving the appropriateness of referrals for obstetric and neonatal emergency cases.]]>
