In most countries, maternal and newborn care is fragmented and focused on identification and treatment of pathology that affects only the minority of women and babies. Recently, a framework for quality maternal and newborn care was developed, which encourages a system-level shift to provide skilled care for all.This care includes preventive and supportive care that works to strengthen women’s capabilities and focuses on promotion of normal reproductive processes while ensuring access to emergency treatment when needed. Midwifery care is pivotal in this framework, which contains several elements that resonate with the main dimensions of primary care. Primary health care is the first level of contact with the health system where most of the population’s curative and preventive health needs can be fulfilled as close as possible to where people live and work. In this paper, we argue that midwifery as described in the framework requires the application of a primary care philosophy for all childbearing women and infants. Evaluation of the implementation of the framework should therefore include tools to monitor the performance of primary midwifery care.
MULTIFILE
Background: In 2009, the Steering Committee for Pregnancy and Childbirth in the Netherlands recommended the implementation of continuous care during labor in order to improve perinatal outcomes. However, in current care, routine maternity caregivers are unable to provide this type of care, resulting in an implementation rate of less than 30%. Maternity care assistants (MCAs), who already play a nursing role in low risk births in the second stage of labor and in homecare during the postnatal period, might be able to fill this gap. In this study, we aim to explore the (cost) effectiveness of adding MCAs to routine first- and second-line maternity care, with the idea that these MCAs would offer continuous care to women during labor. Methods: A randomized controlled trial (RCT) will be performed comparing continuous care (CC) with care-as-usual (CAU). All women intending to have a vaginal birth, who have an understanding of the Dutch language and are > 18 years of age, will be eligible for inclusion. The intervention consists of the provision of continuous care by a trained MCA from the moment the supervising maternity caregiver establishes that labor has started. The primary outcome will be use of epidural analgesia (EA). Our secondary outcomes will be referrals from primary care to secondary care, caesarean delivery, instrumental delivery, adverse outcomes associated with epidural (fever, augmentation of labor, prolonged labor, postpartum hemorrhage, duration of postpartum stay in hospital for mother and/or newborn), women’s satisfaction with the birth experience, cost-effectiveness, and a budget impact analysis. Cost effectiveness will be calculated by QALY per prevented EA based on the utility index from the EQ-5D and the usage of healthcare services. A standardized sensitivity analysis will be carried out to quantify the outcome in addition to a budget impact analysis. In order to show a reduction from 25 to 17% in the primary outcome (alpha 0.05 and bèta 0.20), taking into account an extra 10% sample size for multi-level analysis and an attrition rate of 10%, 2 × 496 women will be needed (n = 992). Discussion: We expect that adding MCAs to the routine maternity care team will result in a decrease in the use of epidural analgesia and subsequent costs without a reduction in patient satisfaction. It will therefore be a costeffective intervention. Trial registration: Trial Registration: Netherlands Trial Register, NL8065. Registered 3 October 2019 - Retrospectively registered.
Background: The dynamics of maternal and newborn care challenge midwifery education programs to keep up-to-date. To prepare for their professional role in a changing world, role models are important agents for student learning. Objective: To explore the ways in which Dutch and Icelandic midwifery students identify role models in contemporary midwifery education. Methods: We conducted a descriptive, qualitative study between August 2017 and October 2018. In the Netherlands, 27 students participated in four focus groups and a further eight in individual interviews. In Iceland, five students participated in one focus group and a further four in individual interviews. All students had clinical experience in primary care and hospital. Data were analyzed using inductive content analysis. Results: During their education, midwifery students identify people with attitudes and behaviors they appreciate. Students assimilate these attitudes and behaviors into a role model that represents their ‘ideal midwife’, who they can aspire to during their education. Positive role models portrayed woman-centered care, while students identified that negative role models displayed behaviors not fitting with good care. Students emphasized that they learnt not only by doing, they found storytelling and observing important aspects of role modelling. Students acknowledged the impact of positive midwifery role models on their trust in physiological childbirth and future style of practice. Conclusion: Role models contribute to the development of students’ skills, attitudes, behaviors, identity as midwife and trust in physiological childbirth. More explicit and critical attention to how and what students learn from role models can enrich the education program.
De recycling van rubberproducten vormt een van de meest uitdagende problemen waar onze samenleving mee te maken heeft. Dit projectvoorstel is gebaseerd op een onderzoek van de Chemical Product Engineering groep van de Rijksuniversiteit Groningen naar alternatieve processen voor devulkanisatie (een proces met giftige en dure chemicaliën), met als doel de productie van verwerkbare rubberderivaten op een industrieel aantrekkelijke manier. Dit is recentelijk gerealiseerd en maakt het mogelijk om rubberproducten (waaronder GTR van autobanden) te recyclen door gebruik te maken van relatie goedkope en onschadelijke chemicaliën. De volgende stap is het formuleren van dit materiaal met andere (afval)materialen om te komen tot circulaire (gerecyclede en recyclebare) producten. Om tot de juiste toepassingen te komen is intensieve samenwerking nodig met de beroepspraktijk. De MKB-bedrijven Newborn Rubber BV en Disrubt BV hebben hiervoor de expertise en motivatie. Zij willen in dit project met de RuG komen tot de definitie van nieuwe producten op basis van de reeds onderzochte soorten gerecycled rubber. Het eerste product (fietskrat van Disrubt) zal worden opgeschaald van het lab van de RuG naar de pilotinstallatie van Newborn Rubber. Hierbij wordt de invloed van thermische en mechanische degradatie onderzocht op de kwaliteit van het geformuleerde product. Ondertussen wordt een samenwerkingsstructuur uitgebouwd waarbij ook andere bedrijven actief deelnemen aan de identificatie van mogelijke rubberbronnen (d.w.z. producten die nu niet gerecycled worden) en geschikte producten na recycling. Onderzoeksvraag: Op welke wijze kunnen we op industriële schaal post-consumer rubberafval samen met andere (afval)componenten verwerken tot nieuwe producten?
