Background: Research in maternity care is often conducted in mixed low and high-risk or solely high-risk populations. This limits generalizability to the low-risk population of pregnant women receiving care from Dutch midwives. To address this limitation, 24 midwifery practices in the Netherlands bring together routinely collected data from medical records of pregnant women and their offspring in the VeCaS database. This database offers possibilities for research of physiological pregnancy and childbirth. This study explores if the pregnant women in VeCaS are a representative sample for the national population of women who receive primary midwife-led care in the Netherlands. Methods: In VeCaS we selected a low risk population in midwife-led care who gave birth in 2015. We compared population characteristics and birth outcomes in this study cohort with a similarly defined national cohort, using Chi Square and two side t-test statistics. Additionally, we describe some birth outcomes and lifestyle factors. Results: Midwifery practices contributing to VeCaS are spread over the Netherlands, although the western region is underrepresented. For population characteristics, the VeCaS cohort is similar to the national cohort in maternal age (mean 30.4 years) and parity (nulliparous women: 47.1% versus 45.9%). Less often, women in the VeCaS cohort have a non-Dutch background (15.7% vs 24.4%), a higher SES (9.9% vs 23.7%) and live in an urbanised surrounding (4.9% vs 24.8%). Birth outcomes were similar to the national cohort, most women gave birth at term (94.9% vs 94.5% between 37 + 0–41+ 6 weeks), started labour spontaneously (74.5% vs 75.5%) and had a spontaneous vaginal birth (77.4% vs 77.6%), 16.9% had a home birth. Furthermore, 61.1% had a normal pre-pregnancy BMI, and 81.0% did not smoke in pregnancy. Conclusions: The VeCaS database contains data of a population that is mostly comparable to the national population in primary midwife-led care in the Netherlands. Therefore, the VeCaS database is suitable for research in a healthy pregnant population and is valuable to improve knowledge of the physiological course of pregnancy and birth. Representativeness of maternal characteristics may be improved by including midwifery practices from the urbanised western region in the Netherlands.
At the beginning of the twenty first century obesity entered Dutch maternity care as a ‘new illness’ challenging maternity care professionals in providing optimal care for women with higher BMI’s. International research revealed that obese women had more perinatal problems than normal weight women. However, the effect of higher BMIs on perinatal outcomes had never been studied in women eligible for midwife-led primary care at the outset of their pregnancy. In the context of the Dutch maternity care system, it was not clear if obesity should be treated as a high-risk situation always requiring obstetrician-led care or as a condition that may lead to problems that could be detected in a timely manner in midwife-led care using the usual risk assessment tools. With the increased attention on obesity in maternity care there was also increased interest in GWG. Regarding GWG in the Netherlands, the effect of insufficient or excessive GWG on perinatal outcomes had never been studied and there were no validated guidelines for GWG. A midwife’s care for the individual woman in the context of the Dutch maternity care system - characterised by ‘midwife-led care if possible, obstetrician-led care if needed’ - is hampered by the lack of national multidisciplinary consensus regarding obesity and weight gain. Obesity has not yet been included in the OIL and local protocols contain varying recommendations. To enable sound clinical decisions and to offer optimal individual care for pregnant women in the Netherlands more insights in weight and weight gain in relation to perinatal outcomes are required. With this thesis the author intends to contribute to the body of knowledge on weight and weight gain to enhance optimal midwife-led primary care for the individual woman and to guide midwives’ clinical decision-making.
Healthy gestational weight gain (GWG) is associated with better pregnancy outcomes and with improved health in the later lives of women and babies. In this thesis the author describes the process of developing an intervention to help pregnant women reach a healthy GWG. The need for this intervention was derived from discussions with midwives, working in primary care in the Netherlands. In this introduction, the author describes the background of the larger project “Promoting Health Pregnancy”, of which this study is a part (1.2), the problem of unhealthy GWG (1.3-1.6) and offers a brief introduction to the theoretical framework of the study and to the subsequent chapters (1.7-1.9).
Sinds de corona reset wordt in de culturele en creatieve sector volop geïnnoveerd om tijdelijke sluitingen en financiële verliezen te compenseren. Aanbieders van hoogwaardige culturele programma’s, zoals presentatie-instellingen en zelforganiserende collectieven, coördineren in hoog tempo digitale expositieruimtes, livestreams en online debatten, waarmee ze hun bestaande (offline en lokale) en nieuwe (online en mondiale) publiek bedienen. Soms ook tegelijkertijd, in een hybride evenement; met een beperkt live publiek én een onbeperkt aantal online bezoekers. Hoe zorgen zij dat beide groepen bij deze livecastings een gelijkwaardige ervaring hebben? En hoe benutten ze de potentie van dit opgenomen materiaal voor publicatie en blijvende publieksinteractie in hun digitaal (web)archief? Ad hoc coronaoplossingen behoeven nu toekomstbestendige doorontwikkeling. Met MKB’ers ontwikkelen we een langetermijnvisie op off/online kennisdeling van hun culturele aanbod, op voorwaarden van duurzaamheid en technologische onafhankelijkheid in het beheer en de data-opslag van hun gepubliceerde materiaal. Verregaande digitalisering en klimaatoverwegingen geven namelijk naast corona urgentie aan een visie op hybride programmering. In het onderzoek worden werkende principes ontwikkeld voor een langetermijnvisie op een hybride en kwalitatief hoogwaardig programma-aanbod, met het oog op het bedienen van nieuw en bestaand publiek na de corona reset, via participatieve livecasts van evenementen, de samenhangende verslaglegging daarvan middels publicaties die uiteindelijk in levende archieven te komen: Om het knelpunt van ‘schermmoeheid’ bij eindgebruikers van programma-aanbod te voorkomen, ontwikkelen we werkende principes in het oplossingsgebied ‘participatieve livecasting’, om de succespijler ‘gezamenlijke publiekservaring bij online evenementen’ te bewerkstelligen. Om het knelpunt van ‘gefragmenteerde informatievoorziening’ bij programma-aanbieders te voorkomen, ontwikkelen we werkende principes in het oplossingsgebied ‘hybride publicaties’, om de succespijler ‘samenhang in off/online programma-aanbod’ te bewerkstelligen. Om het knelpunt van een ‘reactieve houding’ bij programma-aanbieders te voorkomen, ontwikkelen we werkende principes in het oplossingsgebied ‘levende archieven’, om de succespijler van een ‘anticiperende houding in de werkwijze van programma-aanbieders’ te bewerkstelligen.
