Student midwives’ perceptions on the organisation of maternity care and alternative maternity care models in the Netherlands - a qualitative study

Abstract

BackgroundA major change in the organisation of maternity care in the Netherlands is under consideration, going from an echelon system where midwives provide primary care in the community and refer to obstetricians for secondary and tertiary care, to a more integrated maternity care system involving midwives and obstetricians at all care levels. Student midwives are the future maternity care providers and they may be entering into a changing maternity care system, so inclusion of their views in the discussion is relevant. This study aimed to explore student midwives’ perceptions on the current organisation of maternity care and alternative maternity care models, including integrated care.MethodsThis qualitative study was based on the interpretivist/constructivist paradigm, using a grounded theory design. Interviews and focus groups with 18 female final year student midwives of the Midwifery Academy Amsterdam Groningen (AVAG) were held on the basis of a topic list, then later transcribed, coded and analysed.ResultsStudents felt that inevitably there will be a change in the organisation of maternity care, and they were open to change. Participants indicated that good collaboration between professions, including a shared system of maternity notes and guidelines, and mutual trust and respect were important aspects of any alternative model. The students indicated that client-centered care and the safeguarding of the physiological, normalcy approach to pregnancy and birth should be maintained in any alternative model. Students expressed worries that the role of midwives in intrapartum care could become redundant, and thus they are motivated to take on new roles and competencies, so they can ensure their own role in intrapartum care.ConclusionsFinal year student midwives recognise that change in the organisation of maternity care is inevitable and have an open attitude towards changes if they include good collaboration, client-centred care and safeguards for normal physiological birth.The graduating midwives are motivated to undertake an expanded intrapartum skill set. It can be important to involve students’ views in the discussion, because they are the future maternity care providers.

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“…The students consulted coincided with other studies in the view that there persists a certain focus on the biomedical model of care by midwives (Andina & Siles, 2016;Duarte et al, 2020), and that to advance towards women's empowerment a change in the organization of the system is needed GÉNEROS -Multidisciplinary Journal of Gender Studies, 10(3) 248 (Speakman et al, 2014;Warmelink et al, 2017;Hunter et al, 2018;Patil et al, 2017). The participating students' perceptions also coincide with those of other students in the appreciation of certain disrespectful attitudes by midwives towards their users and on the need to pay more attention to the psychosocial aspects of women (Richards et al, 2015;Nieuwenhuijze et al, 2020).…”

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“…Integrated care includes an extended remit for midwives to provide care both medium risk and low risk women. Rates of obstetric interventions in the Netherlands remain still low compared to other industrialized countries [ 17 ], however, there is concern among midwives and others that the change to an integrated model of care may lead to more interventions [ 18 , 19 ].…”