A substantial proportion of Dutch women looked back negatively on their birth experience 3 years postpartum. Further research needs to be undertaken to understand women's expectations and experiences of birth within the Dutch maternity system and an examination of maternity care changes designed to reduce or modify controllable factors that are associated with negative recall.

If the neonatal screening program is to be expanded, parents would prefer for information about the program be given during pregnancy. In addition, they preferred an opt-out consent approach, on condition that screening was for the purpose of preventing irreversible harm. Parental opinion was divided on this issue if the aim of screening were to be widened.

Objective To assess the trends and patterns of referral from midwives to obstetricians within the Dutch maternity care system from 1988 to 2004, and the differences in referral patterns between nulliparous and parous women.Design A descriptive study.Setting The Dutch midwifery database (LVR1), which monitored 74% (1988) Methods The indications for referral from midwifery to obstetric care were classified into fifteen groups (eight antepartum, six intrapartum and one postpartum). The trends in referrals of these indications were analysed by general linear models.Main outcome measures Trends in the percentage of antepartum, intrapartum and postpartum referrals from midwifery care to obstetric care; trends in the specific indications for referral; contribution of different groups of the indications to the trend.Results From 1988 to 2004 an increase of 14.5% (from 36.9 to 51.4%) occurred in referrals from primary midwifery care to secondary obstetric care either during pregnancy, childbirth or in the postpartum period. The timing of the referrals was as follows: antepartum +9.0%, intrapartum +5.2% and postpartum +0.3%. In parous women, the increase in referrals was greater (+16.6%) than in nulliparous women (+12.3%) (P = 0.001). The commonest indications for referrals in nulliparous women were anticipated or evident complications due to 'failure to progress in the first or second stage' and 'fetal distress'. Parous women were most commonly referred for anticipated or evident complications due to 'medical history' and 'fetal distress'. In nulliparous women, 52% of the increase in referrals was related to the need of pain relief and occurrence of meconium-stained amniotic fluid; in parous women, 54% of the increase in referrals was related to the general medical and obstetrical history of the women, particularly previous caesarean section, and the occurrence of meconiumstained amniotic fluid.Conclusions During a 17-year period, there was a continuous increase in the referral rate from midwives to obstetricians. Previous caesarean section, requirement for pain relief and the presence of meconium-stained amniotic fluid were the main contributors to the changes in referral rates. Primary prevention of caesarean section and antenatal preparation for childbirth are important interventions in the maintenance of primary obstetric care for low-risk pregnant women.

Objective To evaluate the success of an external cephalic version (ECV) training programme, and to determine the rates of successful ECV, complications, and caesarean birth in a low-risk population.Design Prospective observational study.Setting Primary health care and hospital settings throughout the Netherlands (January 2008-September 2011).Population Low-risk women with a singleton fetus in breech presentation, without contraindications to ECV, were offered ECV at approximately 36 weeks of gestation.Methods Data were collected for all ECVs performed by midwives, and were entered into a national online database.Main measures Successful ECV was defined as the fetus having a cephalic presentation immediately following the procedure and at birth. Complications were observed at ≤30 minutes and between 30 minutes and 48 hours after the ECV procedure. All serious pregnancy outcomes that occurred after the ECV procedure until birth were reported.Results A total of 47% had a successful ECv and a cephalic at the time of birth: 34% of nulliparous and 66% of multiparous women. After ECV, 57% of women gave birth vaginally: 45% of nulliparous women and 76% of multiparous women. Within 30 minutes after ECV, and between 30 minutes and 48 hours after ECV, the proportion of women experiencing a complication or serious pregnancy outcome was 0.9% and 1.8%, respectively. Serious pregnancy outcome at any time following ECV until birth was experienced by 58 (2.5%) of the women.Conclusions The success rate of ECVs performed by trained midwives in primary health care or hospital settings is comparable with that of other providers, and the procedure is safe for low-risk women.

BackgroundJob satisfaction is generally considered to be an important element of work quality and workplace relations. Little is known about levels of job satisfaction among hospital and primary-care midwives in the Netherlands. Proposed changes to the maternity care system in the Netherlands should consider how the working conditions of midwives affect their job satisfaction.AimWe aimed to measure and compare job satisfaction among hospital and primary-care midwives in the Netherlands.MethodsOnline survey of all practising midwives in the Netherlands using a validated measure of job satisfaction (the Leiden Quality of Work Questionnaire) to analyze the attitudes of hospital and primary-care midwives about their work. Descriptive and inferential statistics were used to assess differences between the two groups.ResultsApproximately one in six of all practising midwives in the Netherlands responded to our survey (hospital midwives n = 103, primary-care midwives n = 405). All midwives in our survey were satisfied with their work (n = 508). However, significant differences emerged between hospital and primary-care midwives in terms of what was most important to them in relation to their job satisfaction. For hospital midwives, the most significant domains were: working hours per week, workplace agreements, and total years of experience. For primary-care midwives, social support at work, work demands, job autonomy, and the influence of work on their private life were most significant.ConclusionAlthough midwives were generally satisfied, differences emerged in the key predictors of job satisfaction between hospital and primary-care midwives. These differences could be of importance when planning workforce needs and should be taken into consideration by policymakers in the Netherlands and elsewhere when planning new models of care.Electronic supplementary materialThe online version of this article (10.1186/s12913-019-4454-x) contains supplementary material, which is available to authorized users.

Although referral guidelines are generally followed by midwives, undocumented women are more at risk of adverse perinatal outcomes and inadequate care than documented ethnic minority women.

When changing the maternity care system it will be a challenge to maintain a high level of experienced job autonomy for professionals. A decrease in job autonomy could lead to a reduction in job related wellbeing and in satisfaction with care among pregnant women.

BackgroundBirth centres are regarded as settings where women with uncomplicated pregnancies can give birth, assisted by a midwife and a maternity care assistant. In case of (threatening) complications referral to a maternity unit of a hospital is necessary. In the last decade up to 20 different birth centres have been instituted in the Netherlands. This increase in birth centres is attributed to various reasons such as a safe and easy accessible place of birth, organizational efficiency in integration of care and direct access to obstetric hospital care if needed, and better use of maternity care assistance. Birth centres are assumed to offer increased integration and quality of care and thus to contribute to better perinatal and maternal outcomes. So far there is no evidence for this assumption as no previous studies of birth centres have been carried out in the Netherlands.DesignThe aims are 1) Identification of birth centres and measuring integration of organization and care 2) Measuring the quality of birth centre care 3) Effects of introducing a birth centre on regional quality and provision of care 4) Cost-effectiveness analysis 5) In depth longitudinal analysis of the organization and processes in birth centres.Different qualitative and quantitative methods will be used in the different sub studies. The design is a multi-centre, multi-method study, including surveys, interviews, observations, and analysis of registration data and documents.DiscussionThe results of this study will enable users of maternity care, professionals, policy makers and health care financers to make an informed choice about the kind of birth location that is appropriate for their needs and wishes.