Objective: To identify reasons for referring and characteristics of midwives who have an independent practice and its relation with the complication that manifested from the cases. Methods: Descriptive analytic case-control. Medical records of patients referred directly to RSCM in January 2016-July 2017 were obtained, then information about midwives and obstetric cases, along with its complications, were collected. Interview and analysis of six characteristics of midwives were conducted. Characteristics analyzed were age, education, training, duration of work experience, number of patients ever treated, also distance and travel time of the referral process. Results: All midwives refer due to inadequate facilities. There is a statistically significant correlation between duration of work experience and number of patients that has been managed, with the complication that manifested from referred cases, with OR 7.036 and 6.032, respectively. Conclusions: Midwives refer due to inadequate facilities, and so patients can be treated immediately. Characteristics that affect midwives in referring are: duration of work experience and number of patients that has been managed. It is necessary to re-evaluate the position of midwives who practiced independently in BPJS, refresher programs, and monitoring by relevant agencies. A larger number of samples and data combination of midwives' and patients' characteristics in referral cases are needed for further research. Confounding and external factors are identified first in order to do a thorough analysis. © 2020 Indonesian Society of Obstetrics and Gynecology. All rights reserved.