Perceived job demands and resources of newly qualified midwives working in primary care settings in The Netherlands.

Objective: The objective of this study is to identify perceived job demands and job resources of newly qualified midwives (NQMs), working in primary midwifery care during their first years in practice. Design/Setting: A qualitative study, with semi-structured group interviews was conducted. Midwives working less than three years in primary midwifery care in the Netherlands were invited to join a focus group interview. Measurements and findings: Five focus group interviews were with 31 participants. Interviews were transcribed and analyzed. Data were analyzed thematically by using the different characteristics of the Job Demands Resources model. Working as a locum midwife is demanding for Dutch NQMs, due to a large number of working hours in different practices and a lack of job security. Decision-making and adapting to local guidelines and collaborations demand a high cognitive load. These aspects of the work context negatively impact NQMs’ work and private life. Working with clients and working autonomously motivates the newly graduates. Support from colleagues and peers are important job resources, although colleagues are also experienced as a job demand, due to their role as employer. Strictness in boundaries, flexibility and sense of perspective are NQMs’ personal resources. On the other hand, NQMs perceived perfectionism and the urge to prove oneself as personal demands. Key conclusions and implications for practice: Dutch NQMs’ first years in primary midwifery care are perceived as highly demanding. In primary care, NQMs usually work as locum midwives, self-employed and in different practices. Working in different practices requires not only working with different client populations and autonomous decision-making, but also requires adaptation to different local working arrangements. Building adequate support systems might help NQMs finding a balance between work and private life by having experienced midwives available as mentors. Furthermore, training and coaching of NQMs help them to become aware of their personal resources and demands and to help them strengthen their personal resources. Improving NQMs’ working position through secure employments require changes in the organization of maternity care in the Netherlands

Ook zwangeren gaan naar de huisarts

Doel: In Nederland heeft de verloskundige of de gynaecoloog de regie over de zorg bij zwangerschap, bevalling en kraambed, maar de huisarts blijft ook voor zwangeren een belangrijke zorgverlener. Wij vergeleken het gebruik van huisartsenzorg (contacten, gestelde diagnoses, medicatievoorschriften en verwijzingen) door zwangere vrouwen met dat door niet-zwangere vrouwen. Methode: Op basis van gegevens uit de NIVEL Zorgregistraties eerste lijn voerden wij een longitudinale analyse uit op de gegevens van 15.123 zwangere en 102.564 niet-zwangere vrouwen van 15-45 jaar, geregistreerd door 84 Nederlandse huisartsenpraktijken over de periode 2007-2009. Resultaten: Zwangeren hadden tijdens de zwangerschap gemiddeld 3,6 contacten met de huisarts (consult, telefonisch, huisbezoek), niet-zwangere vrouwen hadden in een vergelijkbaar tijdsbestek 2,2 contacten. Van de zwangeren had 35% geen enkel contact met de huisarts, van de niet-zwangere vrouwen 50%. Bij zwangeren waren de meest geregistreerde diagnoses ‘zwangerschap’ en ‘urineweginfectie’, bij niet-zwangere vrouwen waren dit ‘urineweginfectie’ en ‘andere gegeneraliseerde/niet gespecificeerde ziekte’. Zwangeren kregen gemiddeld 2,1 medicatievoorschriften, niet-zwangere vrouwen 4,4. Zwangeren werden het vaakst verwezen naar een verloskundige of gynaecoloog, nietzwangere vrouwen het vaakst naar een fysiotherapeut. Conclusie: De huisarts is voor zwangeren weliswaar niet de centrale, maar wel een belangrijke zorgverlener. Daarom is het noodzakelijk dat de rol van de huisarts in de verloskundige zorgketen versterkt wordt en dat in de opleiding meer aandacht besteed wordt aan verloskundige kennis. (aut. ref.

Determinants of late and/or inadequate use of prenatal healthcare in high-income countries: a systematic review

Background: Prenatal healthcare is likely to prevent adverse outcomes, but an adequate review of utilization and its determinants is lacking. Objective: To review systematically the evidence for the determinants of prenatal healthcare utilization in high-income countries. Method: Search of publications in EMBASE, CINAHL and PubMed (1992-2010). Studies that attempted to study determinants of prenatal healthcare utilization in high-income countries were included. Two reviewers independently assessed the eligibility and methodological quality of the studies. Only high-quality studies were included. Data on inadequate use (i.e. late initiation, low-use, inadequate use or non-use) were categorized as individual, contextual and health behaviour-related determinants. Due to the heterogeneity of the studies, a quantitative meta-analysis was not possible. Results: Ultimately eight high-quality studies were included. Low maternal age, low educational level, non-marital status, ethnic minority, planned pattern of prenatal care, hospital type, unplanned place of delivery, uninsured status, high parity, no previous premature birth and late recognition of pregnancy were identified as individual determinants of inadequate use. Contextual determinants included living in distressed neighbourhoods. Living in neighbourhoods with higher rates of unemployment, single parent families, medium-average family incomes, low-educated residents, and women reporting Canadian Aboriginal status were associated with inadequate use or entering care after 6 months. Regarding health behaviour, inadequate use was more likely among women who smoked during pregnancy. Conclusion: Evidence for determinants of prenatal care utilization is limited. More studies are needed to ensure adequate prenatal care for pregnant women at risk

Determinants of prenatal health care utilisation by low-risk women: a prospective cohort study.

Background Prenatal health care is pivotal in providing adequate prevention and care to pregnant women. Aim We examined the determinants of inadequate prenatal health care utilisation by low-risk women in primary midwifery-led care in the Netherlands. Methods We used longitudinal data from the population-based DELIVER study with 20 midwifery practices across the Netherlands in 2009 and 2010 as the experimental setting. The participants were 3070 pregnant women starting pregnancy care in primary midwifery care. Findings We collected patient-reported data on potential determinants of prenatal care utilisation derived from the Andersen model. Prenatal health care utilisation was measured by a revised version of the Kotelchuck Index, which measures a combination of care entry and number of visits. Low-risk pregnant women (not referred during pregnancy) were more likely to use prenatal care inadequately if they intended to deliver at a hospital, if they did not use folic acid adequately periconceptionally, or if they were exposed to cigarette smoke during pregnancy. Among those who were referred to secondary care, women reporting a chronic illnesses or disabilities, and women who did not use folic acid periconceptionally were more likely to make inadequate use of prenatal care. Conclusion Inadequate prenatal health care use in primary midwifery care is more likely in specific groups, and the risk groups differ when women are referred to secondary care. The findings suggest routes that can target interventions to women who are at risk of not adequately using prenatal prevention and care services. (aut. ref.