Development of a Blueprint for Integrated Care for Vulnerable Pregnant Women

H W Harmsen Van Der Vliet-Torij,E A P Steegers,M J B M Goumans,M P Lambregtse-Van Den Berg,J P De Graaf,H J M Van Heijningen-Tousain,J Scheele,E Wingelaar-Loomans,A A Venekamp

doi:10.1007/s10995-021-03340-y

H W Harmsen Van Der Vliet-Torij, E A P Steegers + Show 7 more

Open Access

https://doi.org/10.1007/s10995-021-03340-y

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Abstract

PurposeThere has been increasing awareness of perinatal health and organisation of maternal and child health care in the Netherlands as a result of poor perinatal outcomes. Vulnerable women have a higher risk of these poor perinatal outcomes and also have a higher chance of receiving less adequate care. Therefore, within a consortium, embracing 100 organisations among professionals, educators, researchers, and policymakers, a joint aim was defined to support maternal and child health care professionals and social care professionals in providing adequate, integrated care for vulnerable pregnant women.DescriptionWithin the consortium, vulnerability is defined as the presence of psychopathology, psychosocial problems, and/or substance use, combined with a lack of individual and/or social resources. Three studies focussing on population characteristics, organisation of care and knowledge, skills, and attitudes of professionals regarding vulnerable pregnant women, were carried out. Outcomes were discussed in three field consultations.AssessmentThe outcomes of the studies, followed by the field consultations, resulted in a blueprint that was subsequently adapted to local operational care pathways in seven obstetric collaborations (organisational structures that consist of obstetricians of a single hospital and collaborating midwifery practices) and their collaborative partners. We conducted 12 interviews to evaluate the adaptation of the blueprint to local operational care pathways and its’ embedding into the obstetric collaborations.ConclusionPractice-based research resulted in a blueprint tailored to the needs of maternal and child health care professionals and social care professionals and providing structure and uniformity to integrated care provision for vulnerable pregnant women.

Highlights

There has been increasing awareness of perinatal health and the organisation of maternal and child health care in the Netherlands, because Dutch perinatal outcomes, with a perinatal mortality rate of 7.1 per 1000 in 2004, 5.1 per 1000 in 2010, and 4.2 per 1000 in 2015, appeared to be worse than in most other European countries (Bonsel et al, 2010; Buitendijk et al, 2003; de Jonge et al, 2009; EURO-PERISTAT, 2008, 2010, 2015)
Vulnerable women have a higher risk of worse perinatal outcomes such as severe perinatal morbidity and perinatal mortality
Differences in perinatal outcomes between neighbourhoods can be explained by individual medical risk factors among pregnant women and by differences in psychosocial, non-medical risk factors, such as a low socioeconomic status, a weak social cohesion and unsafe neighbourhoods (Posthumus, 2016; Timmermans et al, 2011)

Summary

Introduction

There has been increasing awareness of perinatal health and the organisation of maternal and child health care in the Netherlands, because Dutch perinatal outcomes, with a perinatal mortality rate of 7.1 per 1000 in 2004, 5.1 per 1000 in 2010, and 4.2 per 1000 in 2015, appeared to be worse than in most other European countries (Bonsel et al, 2010; Buitendijk et al, 2003; de Jonge et al, 2009; EURO-PERISTAT, 2008, 2010, 2015). The four groups unanimously indicated two themes as their focal points: (1) to structure care for pregnant women suffering from psychosocial problems (e.g. lack of social support, relational problems, financial problems, housing problems) and (2) to improve cooperation between maternal and child health care professionals and the organisation ‘Veilig Thuis’ (‘Safe at Home’), a national organisation that supports families that face domestic violence and/or child abuse Outcomes of this second field consultation, were summarized and sent to the advisory board of the consortium and to a minimum of two participants from each of the four groups in the second field consultation. Some interviewees were worried that in the future professionals would forget to use it, due to stress and busy agendas (Wingelaar-Loomans et al, not published)

Discussion

Conclusion for Practice