Tasks and responsibilities of clinical midwives in Dutch hospitals

Background: The number of Dutch clinical midwives has increased substantially over the last 20 years, but their tasks, responsibilities, and formal positions remain unclear. This study aimed to gain insight into the current tasks and responsibilities of clinical midwives in Dutch hospitals. We also aimed to determine whether these tasks varied among three types of hospitals in the Netherlands: secondary nonteaching hospitals, secondary teaching hospitals, and tertiary hospitals. Methods: A cross-sectional national survey in which a questionnaire was sent to 810 clinical midwives from 78 hospitals was conducted. Responses from 412 (51%) clinical midwives from 77 hospitals were included in the analysis. Results: Most respondents (97%) provided care in the delivery wards. They were often involved in the induction of labor (88%), requests for pain relief (87%), cases of meconium-stained fluid (59%), prolonged first-stage labor (56%), and maternal hypertensive disorders (43%). Daily tasks and responsibilities were determined by the type of pathology (60%), caseload in the ward (48%), and years of work experience (28%). The tasks varied according to hospital type, and the majority also conducted non-care-related tasks, such as auditing (83%) and teaching (67%). Conclusions: Dutch clinical midwives play important roles in obstetric care. They provide care for women with a wide range of pathologies they are not always trained for. In addition, they perform non-care-related tasks. Their tasks varied according to hospital type. To ensure that they are both skilled and authorized, compulsory training and formalization of their profession are possible interventions.</p

Bright light therapy in pregnant women with major depressive disorder: Study protocol for a randomized, double-blind, controlled clinical trial

Background: Depression during pregnancy is a common and high impact disease. Generally, 5-10 % of pregnant women suffer from depression. Children who have been exposed to maternal depression during pregnancy have a higher risk of adverse birth outcomes and more often show cognitive, emotional and behavioural problems. Therefore, early detection and treatment of antepartum depression is necessary. Both psychotherapy and antidepressant medication, first choice treatments in a non-pregnant population, have limitations in treating depression during pregnancy. Therefore, it is urgent and relevant to investigate alternative treatments for antepartum depression. Bright light therapy (BLT) is a promising treatment for pregnant women with depressive disorder, for it combines direct availability, sufficient efficacy, low costs and high safety, taking the safety for the unborn child into account as well. Methods: In this study, 150 pregnant women (12-18 weeks pregnant) with a DSM-V diagnosis of depressive disorder will be randomly allocated in a 1:1 ratio to one of the two treatment arms: treatment with BLT (9.000 lux) or treatment with dim red light therapy (100 lux). Both groups will be treated for 6 weeks at home on a daily basis for 30 min, within 30 min of habitual wake-up time. Follow-up will take place after 6 weeks of therapy, 3 and 10 weeks after end of therapy, at birth and 2, 6 and 18 months postpartum. Primary outcome will be the average change in depressive symptoms between the two groups, as measured by the Structured Interview Guide for the Hamilton Depression Scale - Seasonal Affective Disorder version and the Edinburg Postnatal Depression Scale. Changes in rating scale scores of these questionnaires over time will be analysed using generalized linear mixed models. Secondary outcomes will be the changes in maternal cortisol and melatonin levels, in maternal sleep quality and gestational age, birth weight, infant behaviour, infant cortisol exposure and infant cortisol stress response. Discussion: If BLT reduces depressive symptoms in pregnant women, it will provide a safe, cheap, non-pharmacological and efficacious alternative treatment for psychotherapy and antidepressant medication in treating antepartum depression, without any expected adverse reactions for the unborn child. Trial registration: Netherlands Trial Register NTR5476. Registered 5 November 2015

Understanding how midwife-led continuity of care can be implemented and under what circumstances: a realist review

Objectives To understand how and under what circumstances midwife-led continuity of care (MLCC) can be implemented in high-income countries.Design A realist review was conducted to examine interactions between contexts, mechanisms and outcomes.Methods An initial programme theory described a hypothesis of how MLCC might be implemented successfully. Literature from a systematic search on the implementation of MLCC was synthesised and supplemented with unstructured searches to identify literature that reinforced the emerging concepts. The synthesis was an iterative process, endorsed in consultation with stakeholders, leading to a refined programme theory.Results A total of 45 documents were included. The mechanisms identified can be grouped around macrolevel challenges, leadership, role ambiguity and conflict, and personal and professional boundaries. Despite strong evidence supporting MLCC, diverse stakeholder interests and power dynamics hinder its implementation. Implementing MLCC disrupts established roles and power structures, creating uncertainty and anxiety at all levels. To successfully navigate healthcare providers through the transition, both formal and informal leaders must demonstrate the courage and vision to challenge existing norms.Conclusions Realist methodology allowed the identification of mechanisms that often remain unnoticed but significantly impact the implementation of MLCC. Concrete policies and guidelines are essential to ensure consistency in care delivery. Collaborative efforts and a shared philosophy among all stakeholders, combined with strong leadership that builds trust and addresses anxiety, can create a supportive environment for MLCC implementation.PROSPERO registration number CRD42023446437

Perspectives on the importance of parents’ health, health-promoting behaviour, and psychosocial and lifestyle factors during pregnancy on child health outcomes across the life course:A cross-sectional study among parents and professionals

Background: Adverse circumstances during pregnancy are associated with impaired health for children not only during pregnancy and childhood, but also in adulthood. This study evaluates the perspectives of parents and professionals regarding the importance of parents’ health, parents’ health-promoting behaviour, and psychosocial and lifestyle factors of parents during pregnancy on a child’s long-term health outcomes.Methods: A cross-sectional survey study was conducted among parents with a child up to two years (n = 1854) and professionals (n = 322) in a large city in the Netherlands.Results: Most parents and professionals agree that maternal health during pregnancy is important for a child’s health during pregnancy (98%, 99%, respectively), childhood (94%, 97%, respectively), and adulthood (84%, 89%, respectively). Additionally, almost all parents and professionals agree that maternal health-promoting behaviour during preconception (90%, 96%, respectively), pregnancy (97%, 98%, respectively), and childhood (97%, 99%, respectively) is important for a child’s health.Conclusion: Most parents and professionals recognize the importance of parents’ health and well-being, parents’ health-promoting behaviour and psychosocial and lifestyle factors of parents during pregnancy for a child’s health throughout the life course. To optimize public health, there is a need for effective knowledge translation to bridge between recognition and health-promoting behaviour