Addressing a need. Holistic midwifery in the Netherlands: A qualitative analysis

Abstract

The Netherlands has a maternity care system with integrated midwifery care, including the option of home birth for low risk women. A small group of Dutch (holistic) midwives is willing to assist women in high risk pregnancies during a home birth against medical advice. We examined holistic midwives’ motivations and way of practice, in order to provide other maternity care professionals with insight into the way they work and to improve professional relationships between all care providers in the field. An exploratory qualitative research design with a constructivist approach and a grounded theory method were used. We performed in-depth interviews with twenty-four holistic midwives on their motivations for working outside their professional boundaries. Open, axial and selective coding of the interview data was done in order to generate themes. We held a focus group for a member check of the findings. Four main themes were found: 1) The regular system is failing women, 2) The relationship as basis for empowerment, 3) Delivering client centered care in the current system is demanding, and 4) Future directions. One core theme emerged that covered all other themes: Addressing a need. Holistic midwives explained that many of their clients had no other choice than to choose a home birth in a high risk pregnancy because they felt let down by the regular system of maternity care. Holistic midwives appear to deliver an important service. They provide continuity of care and succeed in establishing a relationship with their clients built on trust and mutual respect, truly putting their clients’ needs first. Some women feel let down by the regular system, and holistic midwives may be the last resort before those women choose to deliver unattended by any medical professional. Maternity care providers should consider working with holistic midwives in the interest of good patient care.

Implementing continuity of midwife carer – just a friendly face? A realist evaluation

“…CMC aims to build relationships through frequent care contacts with the same midwife during a woman's care journey [12]. These relationships result in better clinical outcomes and care experiences for women [36,38,41,[44][45][46][47][48][49][50][51][52][53][54] and are thought to work through various mechanisms such as: trust [38, 47-49, 52, 53, 55]; feeling known [49,51,52,56]; feeling empowered or confident [52,53,57], feeling relaxed [52]; emotional support [45,55,58,59]; advocacy [60] and feeling safe [47]. Women in our evaluation said they liked having a relationship with their midwife, 'seeing a friendly face', feeling known and feeling confident in their midwives' abilities.…”

Meta-Synthesis of the Needs of Women Cared for by Midwives During Childbirth in Hospitals

“…Women value the presence of midwives who are supportive but nonintrusive, and needs such as privacy, bodily respect, or respect for social role highlight the importance for women of feeling respected both culturally and physically during childbirth. Midwifery is strongly related to respect for women's cultural and religious leanings (Phiri et al, 2010) and to a holistic (Hollander et al, 2019) and "person-centered" (Fontein-Kuipers et al, 2018;Taylor, 2015) dimension of care. Women entrust themselves to the care of midwives during childbirth and hope to receive respectful care without unnecessary or unwanted interventions or discrimination, which may be perceived as abuse (Jardim & Modena, 2018;Vedam et al, 2019).…”

How to Make the Hospital an Option Again: Midwives’ and Obstetricians’ Experiences with a Designated Clinic for Women Who Request Different Care than Recommended in the Guidelines

“…Some women decline recommended care because they wish to avoid being subjected to the routine interventions performed in hospital care. Throughout the literature it is described how women who seek physiological birth are hindered by a risk-averse system that is dominated by medicalisation and guidelines [ 1 , 7 , 11 , 15 , 16 , 35 ]. Other women experience a lack of choice in our current maternity care services [ 1 , 15 , 16 , 23 , 35 ].…”

“…Throughout the literature it is described how women who seek physiological birth are hindered by a risk-averse system that is dominated by medicalisation and guidelines [ 1 , 7 , 11 , 15 , 16 , 35 ]. Other women experience a lack of choice in our current maternity care services [ 1 , 15 , 16 , 23 , 35 ]. Women deemed high-risk have limited choices regarding place of birth, birthing position, waterbirth or midwifery-led continuity of care during birth [ 16 ].…”