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

Counselling for prenatal anomaly screening - a plea for integration of existential life questions

The availability in many countries of new prenatal anomaly screening methods, such as the non-invasive prenatal test (NIPT), and the potential broadening of testing for genetic conditions, creates an ongoing debate about the accompanying existential dilemmas at both societal level and for individual new parents. In many countries, the main goal of counselling for prenatal anomaly screening is to facilitate the reproductive decision-making process of future parents. Therefore, counsellors share information to enable a woman and her partner to think about the pros and cons of participating in screening, try to clarify possible moral dilemmas, and dwell on existential life questions. In line with the CanMEDS framework, healthcare professionals must combine the role of communicator (providing health education) with that of professional (by recognising and responding to existential life questions while facilitating decision-making). This is not easy but it is essential for providing balanced counselling. At present, counselling tends to be sufficient regarding health education, whereas guidance in decision-making, including attention for existential life questions and philosophy of life, offers room for improvement. In this paper, we suggest slowing down and turning the traditional prenatal counselling encounter upside down by starting as a counselling professional instead of a healthcare information sharing communicator and thus making the story of the woman and her partner, within their societal context, the starting point and the basis of the counselling encounter

Factors involved in the decision to decline prenatal screening with noninvasive prenatal testing (NIPT)

Objective: To investigate factors involved in the decision to decline prenatal screening with noninvasive prenatal testing (NIPT). Method: A questionnaire study was conducted among 219 pregnant women in the Netherlands who had declined prenatal screening with NIPT (TRIDENT-2 study). Respondents were selectively recruited from three hospitals and 19 midwifery practices, primarily located in or near socioeconomically disadvantaged neighborhoods. 44.3% of the respondents were of non-Western ethnic origin and 64.4% were religious. Results: Most respondents (77.2%) found the decision to decline NIPT easy to make, and 59.8% had already made the decision before information about NIPT was offered. These respondents were more often religious, multigravida, and had adequate health literacy. The main reasons to decline NIPT were “I would never terminate my pregnancy” (57.1%) and “every child is welcome” (56.2%). For 16.9% of respondents, the out-of-pocket costs (175 euros) played a role in the decision, and the women in this group were more often nonreligious, primigravida, and had inadequate health literacy. Conclusion: The primary factors involved in the decision to decline NIPT were related to personal values and beliefs, consistent with autonomous choice. Out-of-pocket costs of NIPT hinder equal access for some pregnant women

A cross-country comparison of pregnant women’s decision-making and perspectives when opting for non-invasive prenatal testing in the Netherlands and Belgium

Background: The Netherlands and Belgium have been among the first countries to offer non-invasive prenatal testing (NIPT) as a first-tier screening test. Despite similarities, differences exist in counseling modalities and test uptake. This study explored decision-making and perspectives of pregnant women who opted for NIPT in both countries. Methods: A questionnaire study was performed among pregnant women in the Netherlands (NL) (n = 587) and Belgium (BE) (n = 444) opting for NIPT, including measures on informed choice, personal and societal perspectives on trisomy 21, 18 and 13 and pregnancy termination. Results: Differences between Dutch and Belgian women were shown in the level of informed choice (NL: 83% vs. BE: 59%, p < 0.001), intention to terminate the pregnancy in case of confirmed trisomy 21 (NL: 51% vs. BE: 62%, p = 0.003) and trisomy 13/18 (NL: 80% vs. BE: 73%, p = 0.020). More Belgian women considered trisomy 21 a severe condition (NL: 64% vs. BE: 81%, p < 0.001). Belgian women more frequently indicated that they believed parents are judged for having a child with trisomy 21 (BE: 42% vs. NL: 16%, p < 0.001) and were less positive about quality of care and support for children with trisomy 21 (BE: 23% vs. NL: 62%, p < 0.001). Conclusion: Differences in women's decision-making regarding NIPT and the conditions screened for may be influenced by counseling aspects and country-specific societal and cultural contexts