Opinions of maternity care professionals and other stakeholders about integration of maternity care: a qualitative study in the Netherlands.

Hilde Perdok,Therese Wiegers,Lidewij Henneman,Suze Jans,Corine Verhoeven,Ben Willem Mol,François Schellevis,Ank De Jonge

doi:10.1186/s12884-016-0975-z

Abstract

BackgroundThis study aims to give insight into the opinions of maternity care professionals and other stakeholders on the integration of midwife-led care and obstetrician-led care and on the facilitating and inhibiting factors for integrating maternity care.MethodsQualitative study using interviews and focus groups from November 2012 to February 2013 in the Netherlands. Seventeen purposively selected stakeholder representatives participated in individual semi-structured interviews and 21 in focus groups. One face-to-face focus group included a combined group of midwives, obstetricians and a paediatrician involved in maternity care. Two online focus groups included a group of primary care midwives and a group of clinical midwives respectively. Thematic analysis was performed using Atlas.ti. Two researchers independently coded the interview and focus group transcripts by means of a mind map and themes and relations between them were described.ResultsThree main themes were identified with regard to integrating maternity care: client-centred care, continuity of care and task shifting between professionals. Opinions differed regarding the optimal maternity care organisation model. Participants considered the current payment structure an inhibiting factor, whereas a new modified payment structure based on the actual amount of work performed was seen as a facilitating factor. Both midwives and obstetricians indicated that they were afraid to loose autonomy.ConclusionsAn integrated maternity care system may improve client-centred care, provide continuity of care for women during labour and birth and include a shift of responsibilities between health care providers. However, differences of opinion among professionals and other stakeholders with regard to the optimal maternity care organisation model may complicate the implementation of integrated care. Important factors for a successful implementation of integrated maternity care are an appropriate payment structure and maintenance of the autonomy of professionals.

Highlights

This study aims to give insight into the opinions of maternity care professionals and other stakeholders on the integration of midwife-led care and obstetrician-led care and on the facilitating and inhibiting factors for integrating maternity care
In a midwife-led care model “the midwife is the lead professional in the planning, organisation and delivery of care given to a woman from initial booking to the postnatal period” [1], in an obstetrician-led care model the obstetrician is the lead professional and in a shared care model the responsibility for the organisation and delivery of care is shared between different health care professionals
In the “INtegrated CAre System” study (INCAS), we examined facilitating and inhibiting factors for integration of midwife-led and obstetrician-led care during labour amongst maternity care professionals

Summary

Introduction

This study aims to give insight into the opinions of maternity care professionals and other stakeholders on the integration of midwife-led care and obstetrician-led care and on the facilitating and inhibiting factors for integrating maternity care. Primary care midwives work autonomously and are responsible for the care of 85 % of women at the start of antenatal care (www.perinatreg.nl/uploads/150/153/PRN_jaarboek_2013_ 09122014.pdf). Of all women in midwife-led care at onset of labour 23 % is referred (www.perinatreg.nl/uploads/150/153/PRN_jaarboek_2013_09122014.pdf ). This means that overall approximately two third of all women in the Netherlands give birth in an obstetrician-led care setting. In the Dutch system, a woman may be transported from home to hospital or from one hospital department to another in case of a referral during labour Obstetric nurses assist both midwives and obstetricians and provide nursing care during labour in a hospital. Maternity care assistants assist the primary care midwives during labour and care for women at home during the first week after birth

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