Pregnancy and Labour in the Dutch Maternity Care System: What Is Normal? The Role Division Between Midwives and Obstetricians

Amelink-Verburg, M.P.; Buitendijk, S. E.

doi:10.1016/j.jmwh.2010.01.001

Cited by 72 publications

(60 citation statements)

References 18 publications

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“…With this, the law formally introduced the division of responsibilities between doctors and midwives for pathological and physiological labor, respectively (Amelink-Verburg & Buitendijk, 2010;Drenth, 1998). Although the law strengthened and consolidated the position of the midwives, it simultaneously significantly limited their authority.…”

Section: Formal Division Of Responsibilitiesmentioning

confidence: 99%

“…This led to a ''cooling'' of the relationship between the societies of the midwives and the obstetricians. However by 1992, the Obstetrical Indications List, based on research and on consensus between obstetricians and midwives (Amelink-Verburg & Buitendijk, 2010), was embedded in the Obstetrical manual of the Dutch Gynecological Society, which also described agreements for collaboration between obstetricians and midwives which had been approved by both professional societies. The aim of the manual was, and still is, to optimize collaboration and quality of obstetrical care.…”

Section: Further Formalizationmentioning

confidence: 99%

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An examination of the historical context of interprofessional collaboration in Dutch obstetrical care

Lee

Driessen²,

Houwaart

et al. 2013

Journal of Interprofessional Care

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Collaboration between different groups of health care professionals is often rooted in a long and often difficult history. This history can exert a strong influence on how professionals collaborate and historical tensions can contribute to problems in contemporary practice. However, literature about interprofessional collaboration often ignores the historical underpinnings of collaboration. In this paper, the historical development of interprofessional collaboration between obstetricians and midwives within the setting of Dutch obstetrical care is explored using a review of Dutch and English literature for documents explicitly or implicitly describing the historical development of this collaboration. This literature delineates the establishment of professional boundaries and the formalization of the collaboration between the two professions. It also details the history of physician domination over the midwives both in midwifery practice and education and the relatively recent reversal of this situation. Moreover, the shift in collaborative partner from general practitioner to obstetrician and its effect on collaboration is examined. Insight into the historical foundations of Dutch maternity care collaboration may allow us to understand the origins, and thus formulate possible solutions, for contemporary problems within this collaboration.

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Section: Formal Division Of Responsibilitiesmentioning

confidence: 99%

Section: Further Formalizationmentioning

confidence: 99%

An examination of the historical context of interprofessional collaboration in Dutch obstetrical care

Lee

Driessen²,

Houwaart

et al. 2013

Journal of Interprofessional Care

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show abstract

“…Reasons for referral are listed in the List of Obstetric Indications ( VIL: Verloskundige Indicatie Lijst ), which is regularly updated by a multidisciplinary group of midwives, obstetricians and general practitioners [15,16]. Local protocols developed by midwives and obstetricians are based on the VIL, but may differ in detail.…”

Section: Introductionmentioning

confidence: 99%

Variation in referrals to secondary obstetrician-led care among primary midwifery care practices in the Netherlands: a nationwide cohort study

Offerhaus

Geerts

Jonge

et al. 2015

BMC Pregnancy Childbirth

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BackgroundThe primary aim of this study was to describe the variation in intrapartum referral rates in midwifery practices in the Netherlands. Secondly, we wanted to explore the association between the practice referral rate and a woman’s chance of an instrumental birth (caesarean section or vaginal instrumental birth).MethodsWe performed an observational study, using the Dutch national perinatal database. Low risk births in all primary care midwifery practices over the period 2008–2010 were selected. Intrapartum referral rates were calculated. The referral rate among nulliparous women was used to divide the practices in three tertile groups. In a multilevel logistic regression analysis the association between the referral rate and the chance of an instrumental birth was examined.ResultsThe intrapartum referral rate varied from 9.7 to 63.7 percent (mean 37.8; SD 7.0), and for nulliparous women from 13.8 to 78.1 percent (mean 56.8; SD 8.4). The variation occurred predominantly in non-urgent referrals in the first stage of labour. In the practices in the lowest tertile group more nulliparous women had a spontaneous vaginal birth compared to the middle and highest tertile group (T1: 77.3%, T2:73.5%, T3: 72.0%). For multiparous women the spontaneous vaginal birth rate was 97%. Compared to the lowest tertile group the odds ratios for nulliparous women for an instrumental birth were 1.22 (CI 1.16-1.31) and 1.33 (CI 1.25-1.41) in the middle and high tertile groups. This association was no longer significant after controlling for obstetric interventions (pain relief or augmentation).ConclusionsThe wide variation between referral rates may not be explained by medical factors or client characteristics alone. A high intrapartum referral rate in a midwifery practice is associated with an increased chance of an instrumental birth for nulliparous women, which is mediated by the increased use of obstetric interventions. Midwives should critically evaluate their referral behaviour. A high referral rate may indicate that more interventions are applied than necessary. This may lead to a lower chance of a spontaneous vaginal birth and a higher risk on a PPH. However, a low referral rate should not be achieved at the cost of perinatal safety.

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“…The unique Dutch system of obstetric care system has three risk-based levels of care: primary care (indicated for low risk pregnancies and deliveries, provided by independently practicing midwives), and secondary/tertiary care (indicated for high risk pregnancies, provided by obstetricians) [18]. As the level of care depends on the distinction between low risk and high risk pregnancies, antenatal risk assessment is an important part of Dutch obstetric care [18]. Although social deprivation has been shown to contribute to adverse perinatal health in the Netherlands, standard risk assessment does not include the assessment of non-medical risks of perinatal health [4, 7, 19, 20].…”

Section: Introductionmentioning

confidence: 99%

Design and outline of the Healthy Pregnancy 4 All study

Denktaş

Poeran

Voorst

et al. 2014

BMC Pregnancy Childbirth

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BackgroundPromotion of healthy pregnancies has gained high priority in the Netherlands because of the relatively unfavourable perinatal health outcomes. In response a nationwide study Healthy Pregnancy 4 All was initiated. This study combines public health and epidemiologic research to evaluate the effectiveness of two obstetric interventions before and during pregnancy: (1) programmatic preconception care (PCC) and (2) systematic antenatal risk assessment (including both medical and non-medical risk factors) followed by patient-tailored multidisciplinary care pathways. In this paper we present an overview of the study setting and outlines. We describe the selection of geographical areas and introduce the design and outline of the preconception care and the antenatal risk assessment studies.Methods/designA thorough analysis was performed to identify geographical areas in which adverse perinatal outcomes were high. These areas were regarded as eligible for either or both sub-studies as we hypothesised studies to have maximal effect there. This selection of municipalities was based on multiple criteria relevant to either the preconception care intervention or the antenatal risk assessment intervention, or to both. The preconception care intervention was designed as a prospective community-based cohort study. The antenatal risk assessment intervention was designed as a cluster randomised controlled trial – where municipalities are randomly allocated to intervention and control.DiscussionOptimal linkage is sought between curative and preventive care, public health, government, and social welfare organisations. To our knowledge, this is the first study in which these elements are combined.

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Pregnancy and Labour in the Dutch Maternity Care System: What Is Normal? The Role Division Between Midwives and Obstetricians

Cited by 72 publications

References 18 publications

An examination of the historical context of interprofessional collaboration in Dutch obstetrical care

An examination of the historical context of interprofessional collaboration in Dutch obstetrical care

Variation in referrals to secondary obstetrician-led care among primary midwifery care practices in the Netherlands: a nationwide cohort study

Design and outline of the Healthy Pregnancy 4 All study

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