Royal Dutch Organization of Midwives

AimsTo examine the experiences of inter-professional collaboration of maternity service providers in the Netherlands and to identify potential enhancing and inhibiting factors for inter-professional collaboration within maternity care in the Netherlands.BackgroundGood collaboration between health care professionals is a key element of safe, effective care, but creating a collaborative culture can be challenging. Good collaboration requires, among other things, negotiating different professional orientations and the organizational constraints of hierarchies and scheduling. Good collaboration is especially important in maternity care. In the Netherlands, suboptimal collaboration has been cited as a significant factor in maternal deaths and in adverse incidents occurring in hospitals during evenings, nights, and weekends. In spite of its importance for effective maternity care, little is known about the nature and quality of collaboration between maternity care professionals. In order to fill this gap, we examined the inter-professional collaboration within multi-disciplinary teams (MDTs) providing maternity services in the Netherlands.MethodsOnline survey of MDTs (consisting of hospital and PCMs, doctors, and carers) involved in the provision of maternity services in the Netherlands. We used a validated measure of collaboration (the Leiden Quality of Work Questionnaire) to analyze the attitudes of those involved in the provision of maternity services about multi-disciplinary collaboration in their work. We used descriptive and inferential statistics to assess differences between the groups.Results40% of all respondents were not satisfied with collaboration within their MDT. Overall, mean collaboration scores (MCS) were low. We found significant differences in MCS between professional groups. Midwives – community and hospital based – were pessimistic about collaboration in future models of maternity care.DiscussionIn the Netherlands, collaboration in maternity care is less than optimal. Poor collaboration is associated with negative consequences for patient safety and quality of care. Strategies to address suboptimal collaboration exist; however, no one-size-fits-all approach is identified in the literature.ConclusionSuboptimal collaboration exists within the midwifery model of care in the Netherlands and the relationship between care providers is under pressure. This could affect patient safety and quality of care, according to the literature.PrécisThis paper presents an in-depth examination of the nature of, and attitudes about, collaboration between members of the MDT involved in the provision of maternity services in the Netherlands.

Objectivethe current division between midwife-led and obstetrician-led care creates fragmentation in maternity care in the Netherlands. This study aims to gain insight into the level of consensus among maternity care professionals about facilitators and barriers related to integration of midwife-led and obstetrician-led care. Integration could result in more personal continuity of care for women who are referred during labour. This may lead to better birth experiences, fewer interventions and better outcomes for both mother and infant. Designa descriptive study using a questionnaire survey of 300 primary care midwives, 100 clinical midwives and 942 obstetricians. Settingthe Netherlands in 2013. Participants131 (response 44%) primary care midwives, 51 (response 51%) clinical midwives and 242 (response 25%) obstetricians completed the questionnaire. Findingsthere was consensus about the clinical midwife caring for labouring women at moderate risk of complications. Although primary care midwives themselves were willing to expand their tasks there was no consensus among respondents on the tasks and responsibilities of the primary care midwife. Professionals agreed on the importance of good collaboration between professionals who should work together as a team. Respondents also agreed that there are conflicting interests related to the payment structure, which are a potential barrier for integrating maternity care. Key conclusionsthis study shows that professionals are positive regarding an integrated maternity care system but primary care midwives, clinical midwives and obstetricians have different opinions about the specifications and implementation of this system. Implication for practiceour findings are in accordance with earlier research, showing that it is too early to design a blueprint for an integrated maternity care model in the Netherlands. To bring about change in the maternity care system, an implementation strategy should be chosen that accounts for differences in interests and opinions between professionals.

Indonesia has a major problem with iron deficiency anemia among pregnant women. A new model named the Four Pillars Approach was designed to improve antenatal care for these women. This study aimed to measure the effectiveness of the model in managing pregnant women with iron deficiency anemia. We used a nonrandomized controlled intervention study. The study, with the Four Pillars Approach as intervention versus usual care as its control, was conducted in two provinces in Java (Indonesia) during the period from March 2012 until May 2013. Main outcome measures were a difference of Hb level ≥0.5g/dL, the number of women who attended five or more antenatal care visits, and birthing with a skilled birth attendant. Three hundred fifty-four participants were enrolled in the study. Participants in the intervention group had an adjusted odds ratio of 25.0 (95% CI 12.03-52.03, p=0.001) for increased hemoglobin of ≥0.5g/dL at 35-37weeks of gestation, compared with the control group. In the intervention group, 95.0 percent of women had five or more antenatal care visits, compared with 57.2 percent (p=0.001) in the control group. All births in both groups were assisted by skilled birth attendants. The Four Pillars Approach is effective in increasing the hemoglobin level and the frequency of antenatal care visits of participants when compared with the usual care for pregnant women with anemia.

To identify factors that are associated with a relatively low caesarean section (CS) rate by examining the CS rate in various subgroups in the Netherlands. Cross-sectional analysis. the Netherlands. A total of 685452 births in the Netherlands Perinatal Registry from 2007 to 2010. A modified classification system for CS was used to categorise all women into ten groups. Labour management, mode of delivery, maternal and neonatal morbidity and mortality were assessed according to these ten groups. Caesarean section, labour induction, instrumental delivery, postpartum haemorrhage, perineal laceration, duration of second stage of labour, Apgar score, fetal and neonatal mortality. Total CS rate was 15.6%. Term, nulliparous and parous women with a singleton pregnancy of a fetus in cephalic position and spontaneous onset of labour had CS rates of 9.6 and 1.9% and instrumental birth rates of 19.4 and 2.4%, respectively; 17.3% of births were induced. Among women with a previous CS and term, singleton pregnancies with a fetus in cephalic presentation, 71% had trial of labour, of which 75% had a successful vaginal birth. Of women with multiple gestation, 43% had CS. Women with CS due to 'failure to progress' in the second stage of labour had a median duration of second-stage pushing of almost 2hours in nulliparas and >90minutes in parous women. Several obstetric practice patterns may have contributed to the relatively low overall CS rate in the Netherlands: a relatively low CS rate in term, singleton pregnancies of a fetus in cephalic position and spontaneous onset of labour, relatively low rate of labour induction, a high rate of a trial of labour after a previous CS, the use of vacuum and forceps, and a high proportion of women being taken care of by midwives. The Netherlands has several practice patterns that may have contributed to its relatively low CS rate.