Birthplace in Australia: Processes and interactions during the intrapartum transfer of women from planned homebirth to hospital

© 2017 Elsevier Ltd Objective the aim of the study was to explore the views and experiences of women, midwives and obstetricians on the intrapartum transfer of women from planned homebirth to hospital in Australia. Design a Constructivist Grounded Theory approach was taken, to conceptualise the social interactions and processes grounded in the data. Setting urban and regional areas in four states of south-eastern Australia. Participants semi-structured qualitative interviews were conducted with 36 women, midwives and obstetricians who had experienced an intrapartum homebirth transfer within three years prior to the interview. Interviews were audio recorded and transcribed verbatim. Findings women who were transferred to hospital from a planned homebirth made physical and psychological journeys out of their comfort zone, as they faced the uncertainty of changing expectations for their birth. The trusting relationship between a woman and her homebirth midwife was crucial to women's sense of safety and well-being in hospital. Midwives and obstetricians, when congregating in the hospital birthing rooms of transferred women, also felt out of their comfort zones. This was due to the challenges of converging with others who possessed conflicting paradigms of safety and risk in birth that were at odds with their own, and adapting to different routines, roles and responsibilities. These differences were derived from diverse professional, social and personal influences and often manifested in stereotyping behaviours and ‘us and them’ dynamics. When midwife-woman partnerships were respected as an inclusive part of women's care, collaboration ensued, conflict was ameliorated, and smooth transfers could be celebrated as successes of the maternity care system. Key conclusions supporting woman centred care in homebirth transfers means acknowledging the social challenges of collaborating in the unique context of a transferred woman's hospital birthing room. Understanding the power of the midwife-woman partnership, and its value to the health and well-being of each woman and her baby, is key to facilitating a successful transfer. Implications for practice the midwife-woman partnership played a central role in providing the necessary support and advocacy for women transferred out of their comfort zone. When midwives worked together in an integrated system to provide the necessary care and support for women who were transferred, greater levels of collaboration emerged and women's perceptions of their quality of care was high. In practice, this meant health professionals respecting each other's roles, responsibilities and expertise, and ameliorating ‘us and them’ dynamics

Regional perinatal mortality differences in the Netherlands; care is the question

Background. Perinatal mortality is an important indicator of health. European comparisons of perinatal mortality show an unfavourable position for the Netherlands. Our objective was to study regional variation in perinatal mortality within the Netherlands and to identify possible explanatory factors for the found differences. Methods. Our study population comprised of all singleton births (904,003) derived from the Netherlands Perinatal Registry for the period 2000-2004. Perinatal mortality including stillbirth from 22+0weeks gestation and early neonatal death (0-6 days) was our main outcome measure. Differences in perinatal mortality were calculated between 4 distinct geographical regions North-East-South-West. We tried to explain regional differences by adjustment for the demographic factors maternal age, parity and ethnicity and by socio-economic status and urbanisation degree using logistic modelling. In addition, regional differences in mode of delivery and risk selection were analysed as health care factors. Finally, perinatal mortality was analysed among five distinct clinical risk groups based on the mediating risk factors gestational age and congenital anomalies. Results. Overall perinatal mortality was 10.1 per 1,000 total births over the period 2000-2004. Perinatal mortality was elevated in the northern region (11.2 per 1,000 total births). Perinatal mortality in the eastern, western and southern region was 10.2, 10.1 and 9.6 per 1,000 total births respectively. Adjustment for demographic factors increased the perinatal mortality risk in the northern region (odds ratio 1.20, 95% CI 1.12-1.28, compared to reference western region), subsequent adjustment for socio-economic status and urbanisation explained a small part of the elevated risk (odds ratio 1.11, 95% CI 1.03-1.20). Risk group analysis showed that regional differences were absent among very preterm births (22+0- 25+6weeks gestation) and most prominent among births from 32+0gestation weeks onwards and among children with severe congenital anomalies. Among term births (37+0weeks) regional mortality differences were largest for births in women transferred from low to high risk during delivery. Conclusion. Regional differences in perinatal mortality exist in the Netherlands. These differences could not be explained by demographic or socio-economic factors, however clinical risk group analysis showed indications for a role of health care factors

Bridging between professionals in perinatal care: Towards shared care in The Netherlands

Relatively high perinatal mortality rates in the Netherlands have required a critical assessment of the national obstetric system. Policy evaluations emphasized the need for organizational improvement, in particular closer collaboration between community midwives and obstetric caregivers in hospitals. The leveled care system that is currently in place, in which professionals in midwifery and obstetrics work autonomously, does not fully meet the needs of pregnant women, especially women with an accumulation of non-medical risk factors. This article provides an overview of the advantages of greater interdisciplinary collaboration and the current policy developments in obstetric care in the Netherlands. In line with these developments we present a model for shared care embedded in local 'obstetric collaborations'. These collaborations are formed by obstetric caregivers of a single hospital and all surrounding community midwives. Through a broad literature search, practical elements from shared care approaches in other fields of medicine that would suit the Dutch obstetric system were selected. These elements, focusing on continuity of care, patient centeredness and interprofessional teamwork form a comprehensive model for a shared care approach. By means of this overview paper and the presented model, we add direction to the current policy debate on the development of obstetrics in the Netherlands. This model will be used as a starting point for the pilot-implementation of a shared care approach in the 'obstetric collaborations', using feedback from the field to further improve it. © Springer Science+Business Media New York 2012

Een evaluatie die prikkelt tot verder onderzoek

“Vroedvrouwen noch gynaecologen hebben reden tot tevredenheid, laat staan tot zelfgenoegzaamheid.” Tot deze weinig verhullende conclusie komt de Alkmaarse gynaecoloog Joke Bais in haar proefschrift ‘Risk selection and detection – a critical appraisal of the Dutch obstetric system’[1]. Al blijkt de eerstelijn zwangeren met pathologie op tijd door te verwijzen, de medische indicatiestelling vindt zowel in de eerste- als in de tweedelijn lang niet altijd plaats conform de Verloskundige Indicatielijst

Verwijsbeleid van loskundige praktijken

Steeds vaker worden zwangeren en barenden overgedragen van de eerste naar de tweede lijn. Verloskundigen maken zich zorgen over deze ontwikkeling. Het project VOKS­ eerstelijn heeft als doel de individuele verloskundigenpraktijken inzicht te verschaffen in de achtergronden van hun verwijsbeleid, om zo evaluatie en kwaliteitstoetsing te stimuleren

De verloskundige indicatie lijst: wat is normaal?

Het verloskundig systeem in een land bepaalt welke professionals een vrouw tijdens haar zwangerschap en bevalling zullen begeleiden. Daarbij kent ieder land een meer of minder gespecificeerde rolverdeling tussen deze professionals met ieder hun eigen verantwoordelijkheden in de zorgverlening. In dit opzicht bestaan er wereldwijd grote verschillen. Er blijkt echter een constante factor te zijn in alle verlos- kundige systemen: de rol van de vroedvrouw of verlos- kundige bij het begeleiden van de normale zwanger- schap en baring. Volgens de ‘Definition of the Midwife’, geformuleerd door de International Confederation of Midwives (ICM) in 2005, omvat de zorg door verloskun- digen ‘preventieve maatregelen, het bevorderen van de normale baring en het onderkennen van complicaties’. De Wereld Gezondheids Organisatie noemt ‘de bekwaam- heid in het begeleiden van de normale zwangerschap en baring de kerncompetentie van verloskundigen’. Wereldwijd wordt de verloskundige gezien als ‘een zorg- verlener die de vrouw centraal stelt’, die het als haar taak ziet om vrouwen ‘gezond de normale stadia van hun reproductieve leven te laten doorlopen’ en die een laag-technologisch instrument wil zijn door haar aanwezigheid’