Determinants and underlying causes of frequent attendance in midwife-led care: an exploratory cross-sectional study

Background: An adequate number of prenatal consultations is beneficial to the health of the mother and fetus. Guidelines recommend an average of 5–14 consultations. Daily practice, however, shows that some women attend the midwifery practice more frequently. This study examined factors associated with frequent attendance in midwifery-led care. Methods: We conducted a cross-sectional study in a large midwifery practice in the Netherlands among low-risk women who started prenatal care in 2015 and 2016. Based on Andersen’s behavioral model, we collected data on potential determinants from the digital midwifery’s practice database. Prenatal healthcare utilization was measured by a revised version of the Kotelchuck Index, which measures a combination of care entry and numbers of visits. Logistic regression models were fitted to estimate the likelihood of frequent attendance compared to the recommended number of visits, adjusted for all relevant factors. Separate models were fitted on the non-referred and the referred group of obstetric-led care, as referral was found to be an effect modifier. Results: The prevalence of frequent attendance was 23% (243/1053), mainly caused by worries and/or vague complaints (44%; 106/243). Among non-referred women, 53% (560/1053), frequent attendance was associated with consultation with an obstetrician (OR = 3.99 (2.35–6.77)) and exposure to sexual violence (OR = 2.17 (1.11–4.24)). Among the referred participants, 47% (493/1053), frequent attendance was associated with a consultation with an obstetrician (OR = 2.75 (1.66–4.57)), psychosocial problems in the past or present (OR = 1.85 (1.02–3.35) or OR = 2.99 (1.43–6.25)), overweight (OR = 1.88 (1.09–3.24)), and deprived area (OR = 0.50 (0.27–0.92)). Conclusion: Our exploratory study indicates that the determinants of frequent attendance in midwifery-led care differs between non-referred and referred women. Underlying causes for frequent attendance was mainly because of non-medical reasons. Implication for practice: A trustful midwife-client relationship is known to be needed for clients such as frequent attenders to share more detailed, personal stories in case of vague complaints or worries, which is necessary to identify their implicit needs

Explanatory factors for first and second-generation non-western women’s inadequate prenatal care utilisation: a prospective cohort study

Background Little research into non-western women’s prenatal care utilisation in industrialised western countries has taken generational differences into account. In this study we examined non-western women’s prenatal care utilisation and its explanatory factors according to generational status. Methods Data from 3300 women participating in a prospective cohort of primary midwifery care clients (i.e. women with no complications or no increased risk for complications during pregnancy, childbirth and the puerperium who receive maternity care by autonomous midwives) in the Netherlands (the DELIVER study) was used. Gestational age at entry and the total number of prenatal visits were aggregated into an index. The extent to which potential factors explained non-western women’s prenatal care utilisation was assessed by means of blockwise logistic regression analyses and percentage changes in odds ratios. Results The unadjusted odds of first and second-generation non-western women making inadequate use of prenatal care were 3.26 and 1.96 times greater than for native Dutch women. For the first generation, sociocultural factors explained 43% of inadequate prenatal care utilisation, socioeconomic factors explained 33% and demographic and pregnancy factors explained 29%. For the second generation, sociocultural factors explained 66% of inadequate prenatal care utilisation. Conclusion Irrespective of generation, strategies to improve utilisation should focus on those with the following sociocultural characteristics (not speaking Dutch at home, no partner or a first-generation non-Dutch partner). For the first generation, strategies should also focus on those with the following demographic, pregnancy and socioeconomic characteristics (aged ≤19 or ≥36, unplanned pregnancies, poor obstetric histories (extra-uterine pregnancy, molar pregnancy or abortion), a low educational level, below average net household income and no supplementary insurance.(aut. ref.