Integrale geboortezorg

  

Publicaties 

Referentie

Auteurs: Hilde Perdok, Lidwine Mokkink, Jeroen van Dillen, Myrte Westerneng, Suze Jans, Ben Willem Mol en Ank de Jonge

Titel: "Opinions of Maternity Care Professionals; About Integration of Care During Labor for "Moderate Risk" Indications: A Delphi Study in The Netherlands" Birth 2014.

Abstract

Background: The percentage of referrals during labor from primary midwifeled care to obstetrician-led care has increased over the past years in The Netherlands. Most women are referred for indications with a moderate increase in risk and are looked after by clinical midwives. This study aims to provide insight into the opinions of maternity care professionals about integration of care and involvement of primary care midwives in the intrapartum care of women with "moderate risk" factors.
Methods:  A Delphi study consisting of three rounds was conducted. A purposively selected heterogenic panel of 50 professionals, including obstetricians, primary care midwives, clinical midwives, and obstetric nurses, answered questions anonymously.
Results: Although primary care midwives would like to expand their responsibilities and tasks with respect to "moderate risk" indications, consensus among panel members was only reached concerning prolonged rupture of membranes for which the primary care midwife could remain the caregiver. 
Conclusion: This studt shows that most participants support more integration of care during labor. The lack of consensus among Dutch maternity care professionals with regard to the distribution of responsibilities ans tasks for "moderate risk" indications is a challenge. Further studies should explore how to deal with differences in opinions among professionals when integrating maternity care systems.
(BIRTH, 2014)

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Auteurs: Hilde Perdok, Suze Jans, Corine Verhoeven, Jeroen van Dillen, Ronald Batenburg, Ben Willem Mol, François Schellevis en Ank de Jonge

Titel: "Opinions of professionals about integrating midwife- and obstetrician-led care in The Netherlands" Midwifery 2016.

Abstract

Objective: the 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.
Design: a descriptive study using a questionnaire survey of 300 primary care midwives, 100 clinical midwives and 942 obstetricians.
Setting: the Netherlands in 2013.
Participants: 131 (response 44%) primary care midwives, 51 (response 51%) clinical midwives and 242 (response 25%) obstetricians completed the questionnaire.
Findings: there 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 maternaty care.
Key conclusions: this 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 practice: our 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. (Midwifery, 2016)

Referentie

Auteurs: Hilde Perdok, Suze Jans, Corine Verhoeven, Jeroen van Dillen, Ben Willem Mol en Ank de Jonge

Titel: "Intrapartum Referral from Primary to Secondary Care in The Netherlands: A Retrospective Cohort Study on Management of Labor and Outcomes" Birth 2015.

Abstract

Background: In the Dutch maternity care system, primary care midwives provide care to low-risk women and refer to obstetricians if risks or complications occur. We examined reasons for referral, management of labor, and maternal and neonatal outcomes among women who were referred during labor.
Methods: In a retrospective cohort study, descriptive analyses were perfomed on data obtained from patient records. Six purposively chosen hospitals in The Netherlands participated in the study from June 2011 to February 2012. The study population included 600 pregnant women who were referred during labor from primary to secondary care.
Main outcome measures: Reasons for referral, interventions after referral, mode of delivery, and maternal and neonatal outcomes.
Results: Of women who were referred during labor, three out of four women were referred for moderate risk indications: request for pain relief (30.5%), meconium-stained liquor (25.3%), failure to progress during first stage of labor (14.0%), and prolonged ruptured membranes without contractions (12.5%). Of all women, 65.7 percent had a spontaneous vaginal delivery and 59.7 percent received some kind of pain relief. Acute referral, meaning fetal distress, occured in 5.5 percent. Of the newborns, 2.7 percent had an Apgar score of 7 or less after 5 minutes and 1.2 percent hand an umbilical cord pH < 7.05. Postpartum complications occurred among 11.0 percent of women.
Conclusion: Women who are referred during labor have a high probability of spontaneous vaginal delivery. To improve continuity of care and satisfaction for this group of women, management of labor could be continued by trained primary care midwives. (Birth, 2015) 

Referentie

Auteurs: Hilde Perdok, Suze Jans, Corine Verhoeven, Lidewij Henneman, Therese Wiegers, Ben Willem Mol, François Schellevis en Ank de Jonge

Titel: "Opinions of maternity care professionals and other stakeholders about integration of maternity care: a qualitative study in the Netherlands" BMC Pregnancy and Childbirth 2016.

Abstract

Background: This study aims to give insight into the opinions of maternity care professionals and other stakeholders on the integration of midwife-led care and obstetrician-led care and on the facilitating and inhibiting factors for integrating maternity care.
Methods: Qualitative study using interviews and focus groups from November 2012 to February 2013 in the Netherlands. Seventeen purposively selected staheholders representatives participated in individual semi-strucured interviews and in 21 in focus groups. One face-to-face focus group included a combined group of midwives, obstetricians and a pediatrician involved in maternity care. Two online focus groups included a group of primary care midwives and a group of clinical midwives respectively. Thematic analysis was performed using Atlas.ti. Two researchers independently coded the interview and focus group transcripts by means of a mind map and themes and relations between them were described.
Results: Three main themes were identified with regard to integrating maternity care: client-centred care, continuity of care and task shifting between professionals. Opinions differed regarding the optimal maternity care organisation model. Participants considered the current payment structure an inhibiting factor, whereas a new modified payment structure based on the actual amount of work performed was seen as a facilitating factor. Both midwives and obstetricians indicated that they were afraid to loose autonomy.
Conclusions: an integrated maternity care system may improve client-centred care, provide continuity of care for women during labour and birth and include a shift of responsibilities between health care providers. However, differences of opinions among professionals and other stakeholders with regard to the optimal maternity care organisation model may complicate the implementation of integrated care. Important factors for a successful implementation of integrated maternity care and an appropriate payment structure and maintenaince of the autonomy of professionals. (BMC Pregnancy and Childbirth, 2016)