Janneke gitsels
Midwifery Science, AVAG, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam
Practising midwife in primary care setting with a substantial proportion with psychosocial problems Researcher with interests in vulnerable populations in perinatal care, and prenatal anomaly screeningBesides, she is founder of memorial meetings for parents who lost their child around birth in the area of her midwifery practice
Background
As stated by international guidelines of primary midwifery care, an adequate number of prenatal consultations are beneficial to the health of the mother and foetus through e.g. promotion of a healthy lifestyle and a timely referral to other disciplines.1,2 In 2016, the World Health Organisation stated that at least 8 prenatal consultations in 41 weeks’ gestation is necessary to reduce perinatal mortality.3 In the Netherlands, guidelines recommend an average of 13 to 15 consultations.4 Daily practice, however, shows that in particular vulnerable women with e.g. psychosocial problems attend the midwifery practice more frequently. Determinants of inadequate prenatal healthcare use have been studied at length.2 However, little research has been done in investigating the incidence, determinants, and underlying causes of frequent attendance in prenatal care.
Methods
A case-control study was conducted in a midwifery practice in a medium-sized city near Amsterdam (N=774). The number of consultations was measured by the revised Kotelchuk Index (KI) by Feijen-de Jong et al.2 based on the number of consultations recommended by the Dutch Organisation of Midwives: inadequate (≤50% of expected consultations), intermediate (50-79%), adequate (80-109%), adequate plus (≥110%). Cases had an adequate plus and controls had an adequate number of consultations.
Results
At present, data of 309 clients were extracted. Preliminary results demonstrate that 4% of the participants received intermediate care, 73% adequate care, and 23% adequate plus care. Reasons for frequent attendance were: worries/vague complaints (44%), abdominal complaints (18%) and psychosocial problems (16%). Frequent attendance was associated with obstetrician consultation (p<0.001), Psychiatrist-Obstetrician-Paediatrician consultation (p=0.038), and domestic and/or sexual violence (p=0.034), and was not associated with living in a deprived area (p=0.083). Results on perinatal outcomes will follow.
Discussion
The relative high incidence of frequent attendance leads to a higher workload for midwives, both during prenatal clinic hours and shifts. Further research is needed to investigate the psychosocial problems of the frequent attenders, their perinatal outcomes, and how to provide custom tailored care to them.
Conclusion
Frequent prenatal attendance in primary midwifery care in the Netherlands seems mostly due to psychosocial problems and less with medical issues.
References:
1. International Confederation of Midwives. Essential competencies for basic midwifery practice. 2013.
2. Feijen-de Jong E, Jansen DWMC, Baarveld F, Boerleider A, Spelten E, Schellevis F, Reijneveld SA. Determinants of prenatal healthcare utilization by low-risk women in primary midwifery-led care in the Netherlands: a prospective cohort study. Women[H1] and Birth 2015.
3. WHO, UNICEF. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: World Health Organization; 2016
4. Boer, J. de, Zeeman, K. Prenatale verloskundige begeleiding. Aanbevelingen voor ondersteuning, interactie en voorlichting. KNOV-standaard Wetenschappelijke onderbouwing, 2008 Utrecht.
Studies of and contributions to practice and/or service organisation , The identification and examination of relevant outcomes relating to labour and birth
