Dutch Perinatal System: performance and innovative strategies

The organization of the Dutch perinatal care system is unique since, in contrast to most other high-income countries, certified community midwives play an independent role in the care for pregnant women. Community midwives care for pregnant women with an assumed or estimated low-risk for medical complications starting from the early prenatal until the postpartum period. If during pregnancy no risks are detected, women have the option of delivering at home, at a birthing centre or in a hospital, in all cases under the supervision of their community midwife. Should complications (threaten to) occur, community midwives refer women under their supervision to secondary care by obstetricians in a hospital setting. If necessary, secondary caregivers then refer women who are severely ill and/or have threatened pregnancies to tertiary perinatal care, which is located in academic hospitals and in non-academic hospitals with obstetric high care and neonatal intensive care units. Approximately one out five women directly starts antenatal care at a secondary or tertiary hospital due to their initial high-risk status. The functioning of this unique system depends on the mutual cooperation of the health care professionals involved, the availability of (different) facilities, the absence of financial barriers, and adequate information to the patients