Background: In order to internalize the midwifery philosophy of care and to learn how to advocate for physiological childbirth, student midwives in the Netherlands need learning experiences that expose them to physiological childbirth practices. Increased hospital births, wide variation in non-urgent referrals and escalating interventions impact on learning opportunities for physiological childbirth. Midwifery educators need to find ways to support student agency in becoming advocates of physiological childbirth. Objective: To gather students’ opinions of what they need to become advocates of physiological childbirth. Methods: Focus groups with student midwives (n = 37), examining attitudes regarding what educational programs must do to support physiological childbirth advocacy. Results: Students reported feelings of personal power when the midwifery philosophy of care is internalized and expressed in practice. Students also identified dilemmas associated with supporting woman-centered care and promoting physiological childbirth. Perceived hierarchy in clinical settings causes difficulties, leading students to practice in accordance with the norms of midwife preceptors. Students are supported in the internalization and realization of the midwifery philosophy of care, including physiological childbirth, if they are exposed to positive examples of care in practice and have opportunities to discuss and reflect on these in the classroom. Key conclusion: Midwifery education should focus on strategies that include navigating dilemmas in practice and helping students to express the midwifery philosophy of care in communication with other professionals and with women. Preceptors need to be supported in allowing student midwives opportunities to realize the midwifery philosophy of care, also when this differs from preceptor practice.
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.
Background: The maternity care system in the Netherlands is well known for its support of community-based midwifery. However, regular midwifery practices typically do not offer caseload midwifery care – one-to-one continuity of care throughout pregnancy and birth. Because we know very little about the outcomes for women receiving caseload care in the Netherlands, we compared caseload care with regular midwife-led care, looking at maternal and perinatal outcomes, including antenatal and intrapartum referrals to secondary (i.e., obstetrician-led) care. Methods: We selected 657 women in caseload care and 1954 matched controls (women in regular midwife-led care) from all women registered in the Dutch Perinatal Registry (Perined) who gave birth in 2015. To be eligible for selection the women had to be in midwife-led antenatal care beyond 28 gestational weeks. Each woman in caseload care was matched with three women in regular midwife-led care, using parity, maternal age, background (Dutch or non-Dutch) and region. These two cohorts were compared for referral rates, mode of birth, and other maternal and perinatal outcomes. Results: In caseload midwifery care, 46.9% of women were referred to obstetrician-led care (24.2% antenatally and 22.8% in the intrapartum period). In the matched cohort, 65.7% were referred (37.4% antenatally and 28.3% in the intrapartum period). In caseload care, 84.0% experienced a spontaneous vaginal birth versus 77.0% in regular midwife-led care. These patterns were observed for both nulliparous and multiparous women. Women in caseload care had fewer inductions of labour (13.2% vs 21.0%), more homebirths (39.4% vs 16.1%) and less perineal damage (intact perineum: 41.3% vs 28.2%). The incidence of perinatal mortality and a low Apgar score was low in both groups. Conclusions: We found that when compared to regular midwife-led care, caseload midwifery care in the Netherlands is associated with a lower referral rate to obstetrician-led care – both antenatally and in the intrapartum period – and a higher spontaneous vaginal birth rate, with similar perinatal safety. The challenge is to include this model as part of the current effort to improve the quality of Dutch maternity care, making caseload care available and affordable for more women.
Training nurses and midwives to treat their patients well There are some specific factors facilitating the modification of the nursing and midwifery bachelor curriculum The development of health literacy and respectful and compassionate care competences among bachelor nursing and midwifery students in Tanzania
De Nederlandse geboortezorg kent structurele capaciteitsproblemen, voornamelijk door personeelsgebrek in de ziekenhuizen. Dit leidt tot tijdelijke opnamestops op verloskundeafdelingen van uren tot dagen. Daarnaast is er in toenemende mate concentratie van zorg, waarbij verloskundeafdelingen permanent sluiten. Vrouwen kunnen hierdoor niet altijd binnen de eigen regio bevallen en aanrijtijden naar ziekenhuizen nemen toe. Wanneer een verloskundige voor een poliklinische bevalling naar een ziekenhuis buiten de regio moet, komt de zorg voor de overige cliënten in de praktijk in het gedrang. Dit heeft effecten op veiligheid van zorg, ervaringen van cliënten en op (werk)tevredenheid van verloskundigen. Verloskundigen worden geconfronteerd met gevolgen en oplossingen waar zij onvoldoende grip op hebben. Zij willen meer regie kunnen voeren over de inrichting van zorg die aansluit bij hun kernwaarden en die van cliënten, met behoud van kwaliteit van zorg. Samen met verloskundigen kwamen we tot de onderzoeksvraag: Op welke manieren kunnen eerstelijns verloskundigen eigen regie nemen in de regionale organisatie van hun zorg – in lijn met hun beroepsidentiteit - om nadelige gevolgen van concentratie van zorg en opnamestops te beheersen? Door participatief actieonderzoek werken we binnen dit project aan het identificeren en vormgeven van passende regionale samenwerkingsvormen, die bijdragen aan de toegankelijkheid van de geboortezorg in de regio en met voldoende draagvlak voor implementatie. Dit doen we door 1) een gedragen collectieve beroepsidentiteit binnen de regio te ontwikkelen met een herijking van kritisch kernwaarden. Dit vormt input voor 2) de ontwikkeling van een predictiemodel dat effecten op capaciteit voorspelt. Verloskundigen krijgen hiermee een instrument in handen waarmee zij onderbouwd invloed uit kunnen oefenen op de organisatie van de geboortezorg, ter voorkoming van negatieve effecten van opnamestops en concentratie van zorg. Doel is toegankelijke, kwalitatief goede en duurzame verloskundige zorg te realiseren met samenwerkingsvormen die aansluiten bij kernwaarden van cliënten en verloskundigen.
