Background: Dutch midwives in independent primary care practices care for women as long as they have a normal, healthy pregnancy and birth. However, maternity care in the Netherlands in the 21st century is changing. Most... [ view full abstract ]
Background: Dutch midwives in independent primary care practices care for women as long as they have a normal, healthy pregnancy and birth. However, maternity care in the Netherlands in the 21st century is changing. Most midwifery practices are now organised as group practices with large caseloads and 12 to 24 hour shifts. Referral rates to obstetric care are rising, leading to less continuity of care for women, and the home birth rate has declined to less than 15% in 2015.
The current policy for improving quality of care in the Netherlands is focussed on integration of primary and secondary care in multidisciplinary teams – a move toward ‘shared care’ in place of ‘midwife-led care’. Some midwives have chosen a different course of action, offering one-on-one midwife-led care with a limited caseload of women per practice, calling themselves caseload midwives. In this qualitative research project, I describe the rise of this type of midwife-led care in the Netherlands in the context of a changing maternity care system.
Method: Thirty-eight caseload midwives were identified, 16 of whom were interviewed using a semi-structured interview guide. Thematic content analysis will be performed, using the Complexity theory as an analytical framework.
Results: Preliminary analysis of the interviews shows that the choice for caseload midwifery is mainly driven by personal motives. Working as a caseload midwife offers the respondents more job satisfaction than working in a regular, busy group practice. Most of their clients are attracted to the practice for the one-on-one care. Caseload midwives do not work in isolation: they form informal supportive networks, in which they provide back-up for each other and share professional and scientific midwifery issues.
Discussion: Better understanding of the rise of this type of midwife-led care offers important lessons for the further development of the midwifery profession and the maternity care system in the Netherlands. More knowledge about the organisation and results of these type of midwifery practices is needed in order to assess the value – in terms of cost, risks, benefits, and scalability – for the future landscape of maternity care in the Netherlands.
Studies of and contributions to practice and/or service organisation
