Improving interprofessional coordination in Dutch midwifery and obstetrics: a qualitative study

Abstract

BackgroundCoordination between the autonomous professional groups in midwifery and obstetrics is a key debate in the Netherlands. At the same time, it remains unclear what the current coordination challenges are.MethodsTo examine coordination challenges that might present a barrier to delivering optimal care, we conducted a qualitative field study focusing on midwifery and obstetric professional’s perception of coordination and on their routines. We undertook 40 interviews with 13 community midwives, 8 hospital-based midwives and 19 obstetricians (including two resident obstetricians), and conducted non-participatory observations at the worksite of these professional groups.ResultsWe identified challenges in terms of fragmented organizational structures, different perspectives on antenatal health and inadequate interprofessional communication. These challenges limited professionals' coordinating capacity and thereby decreased their ability to provide optimal care. We also found that pregnant women needed to compensate for suboptimal coordination between community midwives and secondary caregivers by taking on an active role in facilitating communication between these professionals.ConclusionsThe communicative role that pregnant women play within coordination processes underlines the urgency to improve coordination. We recommend increasing multidisciplinary meetings and training, revising the financial reimbursement system, implementing a shared maternity notes system and decreasing the expertise gap between providers and clients. In the literature, communication by clients in support of coordination has been largely ignored. We suggest that studies include client communication as part of the coordination process.

Interprofessional cooperation by midwives in the field of out-of-hospital obstetrical care: an integrative review / Interprofessionelle Kooperation von Hebammen im Handlungsfeld der ambulanten geburtshilflichen Versorgung: ein integratives Review

“…Apart from this, the health care services of both countries monitor the children from birth on up to toddler age; in Australia, this is carried out by child and family health nurses, in Sweden by child health care nurses (Barimani & Hylander, 2008;Homer et al, 2009). In six other studies, the primary interest lies in interprofessional cooperation between midwives and physicians (Ratti et al, 2014;Schölmerich et al, 2014;Shaw, 2013;Skinner & Foureur, 2010;Smith et al, 2009;Vedam et al, 2012). Three studies examine the introduction of child or family health promotion programmes involving various groups of professions (Edvardsson et al, 2011;Edvardsson et al, 2012;Schmied et al, 2015), while four studies focus on the cooperation between professions in the health and social service sectors (Ayerle et al, 2014;Clancy, Gressnes, & Svensson, 2013;Miers & Pollard, 2009;While, Murgatroyd, Ullman, & Forbes, 2006).…”

“…This means that information can be exchanged during official meetings, for instance, or perhaps in the tearoom during a break (Barimani & Hylander, 2012). Numerous studies have described meetings between the various groups of professions to be conducive to cooperation (Barimani & Hylander, 2008;Edvardsson et al, 2011;Homer et al, 2009;Miers & Pollard, 2009;Schölmerich et al, 2014;Schmied et al, 2015), enabling the faces to be put to the voices that are already known (Barimani & Hylander, 2008) and ensuring that the participants understand each other (Miers & Pollard, 2009). Meetings can provide an insight into activities in other professions and also reveal synergies (Edvardsson et al, 2011) or counteract any lack of communication or any mistrust that might exist between the professional groups (Ratti et al, 2014).…”

“…A number of studies broach the issue of communication problems between the groups of professions and their effect on collaboration (Barimani & Hylander, 2008;Homer et al, 2009;Nagel-Brotzler et al, 2005;Schölmerich et al, 2014;Schmied et al, 2015;Shaw, 2013;Smith et al, 2009). Poor communication jeopardises the efficacy of working relationships (Murray-Davis et al, 2011;Psaila et al, 2015) and is identified as a 'key barrier' (Shaw, 2013), 'key problem' or as 'an elephant in the room' .…”

“…Midwives experience this lack of communication more often as an impediment for collaboration in the context of maternity care than obstetricians or family physicians do (Smith et al, 2009). Three studies present an overview of the communication difficulties between midwives and physicians (Nagel-Brotzler et al, 2005;Schölmerich et al, 2014;Shaw, 2013), showing that pregnant women may take on an active, communicative-supportive role by transferring information between the professional groups (Schölmerich et al, 2014).…”

“…In contrast, a 'link perspective', in which one's own abilities are prioritised and tasks are not seen as part of a comprehensive care provision system, has a restraining influence on the cooperation (Barimani & Hylander, 2008;Barimani & Hylander, 2012). Some studies address topics of cooperation from different perspectives of the professional groups (Barimani & Hylander, 2008;Barimani & Hylander, 2012;Munro et al, 2013;Murray-Davis et al, 2011;, others focus explicitly on the differing perspectives between midwives and physicians (Ratti et al, 2014;Schölmerich et al, 2014;Shaw, 2013;Smith et al, 2009;Vedam et al, 2012), which result in tension and conflict, mistrust, and a lack of respect (Ratti et al, 2014). Whereas 60.7% of the midwives who took part in a quantitative survey described different perspectives as being a central impediment for interprofessional cooperation with physicians, only 46.5% of the obstetricians and 23.3% of the family physicians asked were of the same opinion (Smith et al, 2009).…”