Informed by the suggestions of women, care to women and their families could be improved by the following: 1) more continuity of the care provider during the prenatal, natal, and postnatal periods, 2) more information and information specifically tailored for the person, 3) client-centered communication, and 4) a personal approach with 5) enough time spent per client.

Birth-related factors were more likely than maternal characteristics to be associated with the experience of midwifery care during childbirth. We conclude that there is room for midwives to improve their care for women during childbirth particularly in improving the patient centeredness of the care provider, using strategies to enhance sense of control, and focusing on the particular needs of those who experience instrumental vaginal or unplanned cesarean births.

The approach to care in the Netherlands addresses the needs as outlined by NICE and WHO. Although no data exists around the impact of use on maternal infant outcomes, this approach might be useful in other jurisdictions. MCA care might be improved if the hours of MCA care were tailored, and care by multiple MCAs minimised.

BACKGROUND:The Netherlands maintain a high rate of home births relative to other well-resourced countries. Maternity care assistants (MCAs) play an important role, as part of the maternity care team, assisting the midwife during birth and providing postpartum care to women and babies in their homes. A Cochrane review recently described the advantages of continuous support during childbirth. We were interested in the opinions of MCAs about them having an expanded role to include continuous emotional support during childbirth as well as medical tasks such as checking the condition of the fetus and maternal labor progress through internal examination.METHODS:To explore the opinions of MCAs, four semistructured group discussions took place and 190 questionnaires were sent out to MCAs nationally.RESULTS:In both the group discussions and questionnaires, MCAs displayed positive attitudes toward providing continuous support during childbirth. In general, MCAs were not keen on adding medical tasks. The importance of a clear distribution of responsibilities between midwives and MCAs was reported. Most (60.0%) thought midwives would appreciate MCAs providing continuous support. Furthermore, 40.5% disagreed with dividing the profession into childbirth care and postpartum care teams. Two-thirds mentioned the need for extra training in childbirth assistance.CONCLUSION:In general, MCAs were positive about providing continuous support during childbirth. Most MCAs think that it is unwise to give MCAs additional medical responsibilities. The opinions differ concerning issues of practical organization. MCAs generally thought extra schooling was important to be and feel competent to assist childbirth.

AIMSTo quantify the preferences and preparations for support during labor and the first hours after childbirth of pregnant women and the specific preference for continuous support. To investigate the association with parity and the intended place of birth.DESIGNCross-sectional survey.METHODSTwelve midwifery practices in the northern Netherlands recruited pregnant women.Measurements of the structured questionnaire were preparation for childbirth and preference for support (timing, including continuous support, provider, and type of support)RESULTSTwo hundred and five of the 247 eligible women participated. Nulliparae, significantly more often than multiparae, aimed to prepare themselves by attending prenatal classes (63% vs. 21%) and by creating a birth plan (59% vs. 40%). Women preferred to receive various types of support during childbirth from their partner (100%), midwife (95%), Maternity Care Assistant (29%), and nurse (15%). The women preferred the midwife to be present from the moment the midwife (48%) or the woman herself (22%) indicated a need for the midwife. Among the participants, 10% of the women preferred continuous support from 4 cm dilation.CONCLUSIONWe consider the best approach to continuous support to be that it should be available on request rather than either not being available or being the standard care.