Perinatal outcomes of frequent attendance in midwifery care in the Netherlands: a retrospective cohort study

Background Over the last decade, a trend towards high utilisation of primary maternity care was observed in high-income countries. There is limited research with contradictory results regarding frequent attendance (FA) and perinatal outcomes in midwifery care. Therefore, this study examined possible associations between FA in midwifery care and obstetric interventions and perinatal outcomes. Methods A retrospective cohort study was performed in a medium-sized midwifery-led care practice in an urban region in the Netherlands. Frequent attenders (FAs) were categorised using the Kotelchuck-Index Revised. Regression analyses were executed to examine the relationship between FAs and perinatal outcomes, stratified by antenatal referral to an obstetrician. Main outcomes of interest were Apgar score ≤ 7 and perinatal death, birth weight, mode of delivery, haemorrhage, place of birth, transfer during labour, and a requirement for pain relief. Results The study included 1015 women, 239 (24%) FAs and 776 (76%) non-FAs, 538 (53%) were not referred and 447 (47%) were referred to an obstetrician. In the non-referred group, FA was significantly associated with a requirement for pain relief (OR 1.98, 95% CI 1.24–3.17) and duration of dilatation (OR 1.20, 95% CI 1.04–1.38). In the referred group, FA was significantly associated with induction of labour (OR 1.86, 95% CI 1.17–2.95), ruptured perineum (OR 0.50, 95% CI 0.27–0.95) and episiotomy (OR 0.48, 95% CI 0.24–0.95). In the non-referred and the referred group, FA was not associated with the other obstetric and neonatal outcomes. Due to small numbers, we could not measure possible associations of FA with an Apgar score ≤ 7 and perinatal death. Conclusion In our study, perinatal outcomes differed by FA and antenatal referral to an obstetrician. In the non-referred group, FA was significantly associated with medical pain relief and duration of dilatation. In the referred group, FA was significantly associated with induction of labour, ruptured perineum, and episiotomy. Further research with a larger study population is needed to look for a possible association between FA and primary adverse birth outcomes such as perinatal mortality

Safety of aspirin for preeclampsia prevention

In de tweede lijn schrijven gynaecologen zwangere vrouwen die een hoog risico op pre-eclampsie lopen steeds vaker aspirine voor. De laatste tijd krijgen ook huisartsen regelmatig een verzoek om een aspirinerecept. Maar is aspirine wel veilig voor de (on)geboren baby? Recente publicaties laten zien dat aspirinegebruik tijdens de zwangerschap niet schadelijk is voor het kind. Huisartsen lijken daarom veilig aspirine voor te kunnen schrijven aan een zwangere vrouw, mits daar een indicatie voor is

Safety of aspirin for preeclampsia prevention

In de tweede lijn schrijven gynaecologen zwangere vrouwen die een hoog risico op pre-eclampsie lopen steeds vaker aspirine voor. De laatste tijd krijgen ook huisartsen regelmatig een verzoek om een aspirinerecept. Maar is aspirine wel veilig voor de (on)geboren baby? Recente publicaties laten zien dat aspirinegebruik tijdens de zwangerschap niet schadelijk is voor het kind. Huisartsen lijken daarom veilig aspirine voor te kunnen schrijven aan een zwangere vrouw, mits daar een indicatie voor is

Safety of aspirin for preeclampsia prevention

In de tweede lijn schrijven gynaecologen zwangere vrouwen die een hoog risico op pre-eclampsie lopen steeds vaker aspirine voor. De laatste tijd krijgen ook huisartsen regelmatig een verzoek om een aspirinerecept. Maar is aspirine wel veilig voor de (on)geboren baby? Recente publicaties laten zien dat aspirinegebruik tijdens de zwangerschap niet schadelijk is voor het kind. Huisartsen lijken daarom veilig aspirine voor te kunnen schrijven aan een zwangere vrouw, mits daar een indicatie voor is

Safety of aspirin for preeclampsia prevention

In de tweede lijn schrijven gynaecologen zwangere vrouwen die een hoog risico op pre-eclampsie lopen steeds vaker aspirine voor. De laatste tijd krijgen ook huisartsen regelmatig een verzoek om een aspirinerecept. Maar is aspirine wel veilig voor de (on)geboren baby? Recente publicaties laten zien dat aspirinegebruik tijdens de zwangerschap niet schadelijk is voor het kind. Huisartsen lijken daarom veilig aspirine voor te kunnen schrijven aan een zwangere vrouw, mits daar een indicatie voor is

Safety of aspirin for preeclampsia prevention

In de tweede lijn schrijven gynaecologen zwangere vrouwen die een hoog risico op pre-eclampsie lopen steeds vaker aspirine voor. De laatste tijd krijgen ook huisartsen regelmatig een verzoek om een aspirinerecept. Maar is aspirine wel veilig voor de (on)geboren baby? Recente publicaties laten zien dat aspirinegebruik tijdens de zwangerschap niet schadelijk is voor het kind. Huisartsen lijken daarom veilig aspirine voor te kunnen schrijven aan een zwangere vrouw, mits daar een indicatie voor is

Safety of aspirin for preeclampsia prevention

In de tweede lijn schrijven gynaecologen zwangere vrouwen die een hoog risico op pre-eclampsie lopen steeds vaker aspirine voor. De laatste tijd krijgen ook huisartsen regelmatig een verzoek om een aspirinerecept. Maar is aspirine wel veilig voor de (on)geboren baby? Recente publicaties laten zien dat aspirinegebruik tijdens de zwangerschap niet schadelijk is voor het kind. Huisartsen lijken daarom veilig aspirine voor te kunnen schrijven aan een zwangere vrouw, mits daar een indicatie voor is

How to improve newly qualified midwives' transition-into-practice:A Delphi study

BACKGROUND: In the Netherlands, newly qualified midwives start work as registered midwives without any formal transition support. Research shows that newly qualified midwives do not feel sufficiently confident and competent in their work during the period following graduation. This could impact the quality of care provided by newly registered midwives. The aim of this study is to seek consensus with stakeholders concerning viable components of support for newly qualified midwives working in midwifery care in the Netherlands.METHODS: A Delphi study was conducted among maternity care stakeholders in the Netherlands. During two rounds, sixteen statements derived from a theoretical framework of organizational socialization theory and previous studies were assessed (round 1, n = 56; round 2, n = 52). Stakeholders (N = 61) were invited and completed an online questionnaire that included spaces for opinions and remarks.RESULTS: Stakeholders agreed about an introductory support period for newly qualified midwives, involving performance feedback and regional-level backup from fellow midwives during shifts. They further agreed on the responsibilities of established professionals that they should support newcomers in practice and provide mentoring or group coaching, although they face organizational barriers for supporting newcomers.CONCLUSIONS: Stakeholders found consensus upon several components of support at the workplace. In addition, a stable work environment seemed less important in their opinion while previous research suggests otherwise. Practice organisations need to improve the employment conditions and support for newly qualified midwives to ensure the quality of midwifery care is guaranteed.</p

Midwives’ perceptions of the performance- and transition into practice of newly qualified midwives, a focus group study

Problem: Newly qualified midwives in the Netherlands perceive the adaptation to new responsibilities as difficult due to the autonomous nature of- and required accountability for the work they face in practice. Background: All Dutch newly qualified midwives are accountable for their work from the moment of registration while usually working solistically. Aim: This paper explores the perceptions of experienced midwives regarding: (1) the performance- and transition into practice of newly qualified midwives, and (2) their supporting role in this transition. Methods: The design of this study is qualitative with focus groups. Experienced midwives’ perceptions were explored by means of seven semi-structured focus groups (N = 46 participants) with two meetings for each focus group. Findings: Community-based and hospital-based midwives perceived newly qualified midwives as colleagues who did not oversee all their tasks and responsibilities. They perceived newly qualified midwives as less committed to the practice organisation. Support in community-based practices was informally organised with a lack of orientation. In the hospital-based setting, midwives offered an introduction period in a practical setting, which was formally organised with tasks and responsibilities. Experienced midwives recognised the need to support newly qualified midwives; however, in practice, they faced barriers. Discussion: The differences in experienced midwives’ expectations of newly qualified midwives and reality seemed to depend on the newly qualified midwives’ temporary working contracts and -context, rather than the generational differences that experienced midwives mentioned. Dutch midwives prioritised their work with pregnant individuals and the organisation of their practice above supporting newly qualified midwives

How to improve newly qualified midwives' transition-into-practice:A Delphi study

BACKGROUND: In the Netherlands, newly qualified midwives start work as registered midwives without any formal transition support. Research shows that newly qualified midwives do not feel sufficiently confident and competent in their work during the period following graduation. This could impact the quality of care provided by newly registered midwives. The aim of this study is to seek consensus with stakeholders concerning viable components of support for newly qualified midwives working in midwifery care in the Netherlands.METHODS: A Delphi study was conducted among maternity care stakeholders in the Netherlands. During two rounds, sixteen statements derived from a theoretical framework of organizational socialization theory and previous studies were assessed (round 1, n = 56; round 2, n = 52). Stakeholders (N = 61) were invited and completed an online questionnaire that included spaces for opinions and remarks.RESULTS: Stakeholders agreed about an introductory support period for newly qualified midwives, involving performance feedback and regional-level backup from fellow midwives during shifts. They further agreed on the responsibilities of established professionals that they should support newcomers in practice and provide mentoring or group coaching, although they face organizational barriers for supporting newcomers.CONCLUSIONS: Stakeholders found consensus upon several components of support at the workplace. In addition, a stable work environment seemed less important in their opinion while previous research suggests otherwise. Practice organisations need to improve the employment conditions and support for newly qualified midwives to ensure the quality of midwifery care is guaranteed.</p