Title: Midwifery care and Royal Association of Midwives in the Netherlands
1Midwifery care and Royal Association of Midwives
in the Netherlands
- Marian van Huis
- President
- April 2005
2- Midwifery care system
- The KNOV and Dutch Midwives
- Members, organization
- Challenges and threats
- Summary
3Health care system in the Netherlands
- General philosophy
- avoid unnecessary medicalization
- Primary care client focussed care at home or in
neighbourhood - Secondary care specialist care in hospital or
secondary care surroundings
4Dutch Obstetrical System 1
Primary care ? low risk pregnancies
(physiological pregnancies) - Primary care
Midwives - General Practitioners providing
obstetrical care
- Secondary care ? high risk pregnancies
(pathological pregnancies) - Obstetricians
- Secondary care Midwives
Communication between obstetrician and midwife /
G.P. about pregnancies with an increased risk
5Dutch Obstetrical System 2
Primary care - Home delivery - Voluntary
hospital delivery (with indispensable
maternity aid) - Condition of proper ambulance
transport (45)
Secondary care - Always hospital delivery
(with indispensable obstetrical nursing
care) Selection procedure occurs in primary
setting
Midwifegatekeeper
6KNOV 1
- - Midwifery organization since 1898
- 1998 NOV Royal status ? KNOV
- Aims
- Strengthens position of midwives in health care
system (union work) - Improves quality of midwifery care (standards,
guidelines etc.) - Official representative body of midwives
- Takes care of common interests
7KNOV 2
- Members 2757
- 1187 Independent
- 315 Locum midwives
- 384 Midwives working in secondary care
- Others extraordinary members and students (871)
Age range lt 40 years of age 60 gt 55 years
of age 8 2 male midwives (45)
8The Dutch Midwife 1
- 4 year training at professional higher
educational level - Autonomous medical profession
- Located at Rotterdam, Maastricht and Amsterdam
with - an annex in Groningen since 01-09-2001
- Post graduate education program Masters at
University level - Plans to situate basic training at academic
level - Within 2 years students 120 ? 240 (gt500
applications) - Increasing numbers of midwives 1995 ? 1276
- 2004 ? 1955
53
9The Dutch Midwife 2
- New Professional profile
- Focus on reproductive health
- - preconceptional consultation ? lifestyle like
- smoking, obesity, drinking, folic acid
- - information on prenatal screening and tests
- for example HIV
- Prenatal screening ? counselling, ultra sound,
blood tests - Contraception
- Care during menopause
- ? Risk selection
10The Dutch Midwife 3
- Solo practice 1990 ? 37 2004 ? 9
- Duo practice 1990 ? 38 2004 ? 18
- Group practice 1990 ? 25 2004 ? 74
Check ups during pregnancy ? 10 to 12
times Delivery ? average 12 to 24
hours Postnatal check up ? 5 to 7
times Postnatal check up at 6 weeks
11 Independent practices
12The Dutch Midwife 4
- In 2004 193.000 deliveries
- Of all pregnancies (high and low risk)
- Starting in primary care 86
- Delivery under care of primary care 40,3 (G.P.
6) - Homebirth 30 (throughout), in 2001 28.1 in
2002 28.9
- Physiological pregnancies under the care of the
Midwife / G.P. - 72 Home delivery
- 28 Voluntary hospital delivery
13Home deliveries(absolute numbers)
14Total number of deliveries in the Netherlands
15Home deliveriesin the Netherlands1965 2002
After 1975 possibility of voluntary hospital
deliveries by primary care midwives
16Start care in primary care(percentage)
17Referrals (overall group)
Audit in quality system Thorton, Taylor. The
management of normal labour. Obstetrician
Gynaecologist. April 2001.
18Challenges
- Clients want midwifery care and home birth
- Support of government and health insurances
- for strong primary care
- Capacity problem is solved
- New professional profile with more challenges
- Career perspective and possibility of job
rotation
19Threats
- Midwives used to different referral pattern due
to capacity problem more time with client during
labour - Midwives like to prefer more regulated working
times instead of independent entrepreneur - New health care insurance system ? more market
driven and more competition - Hospitals want to broaden grip on health care cq.
primary obstetrical care - Gynaecologists dont want any division between
primary and secondary care anymore cq. want to
have control over total field of obstetrics
20Summary
- Midwife paramount within health sector
- Midwives indispensable
- Less vulnerable organizational structure
- More cooperation within the health sector,
especially - in primary care
21Home birth the best choice