Transforming maternity care: obstetric partnerships as a policy instrument for integration

T.J Schuitmaker-Warnaar,S.R Lips,J.M Molenaar

doi:10.1016/j.healthpol.2020.05.019

Abstract

Increasing continuity in Dutch maternity care is considered pivotal to improve safety and client-centeredness. Closer collaboration between the historically relatively autonomous professionals and organizations in maternity care is deemed conditional to reach this goal, both by maternity care professionals and policy makers. Governmental policy therefore strives for organizational and financial integration. One of the policy measures has been to stimulate interprofessional and interorganizational collaboration through local obstetric partnerships. This study aimed to gain insight into whether this policy measure supported professionals in reaching the policy aim of increasing integration in the maternity care system. We therefore conducted 73 semistructured interviews with maternity care professionals in the region Northwest Netherlands, from 2014 to 2016. Respondents expressed much willingness to intensify interprofessional and interorganizational collaboration and experienced obstetric partnerships as contributing to this. As such, stimulating integration through obstetric partnerships can be considered a suitable policy measure. However, collaborating within the partnerships simultaneously highlighted deep-rooted dividing structures (organizational, educational, legal, financial) in the maternity care system, especially at the systemic level. These were experienced to hinder collaboration, but difficult for the professionals to influence, as they lacked knowledge, skills, resources and mandate. A lack of clear and timely guidance and support from policy, counterbalancing these barriers, limited partnerships' potential to unify professionals and integrate their services.

Highlights

While most developed countries moved towards hospitalizing childbirth, the Netherlands ‘maintained a system in which community-based midwifery played a dominant and essential role’ [1,2]
In this study we investigated how maternity care professionals experience collaborating in obstetric partnerships
In 2013, the region knew approximately 3,1 million inhabitants, and its 35.000 births comprised around 20% of the national total, making it the largest consortium in the Netherlands [52]. 2 tertiary and 16 secondary care general hospitals were embedded in 18 active obstetric partnerships, which were all included in this study [53,50]

Summary

Introduction

While most developed countries moved towards hospitalizing childbirth, the Netherlands ‘maintained a system in which community-based midwifery played a dominant and essential role’ [1,2]. This model has been considered an exemplary way to limit the medicalization of maternity care [3]. Depending on whether health risks are expected, or arise during pregnancy or childbirth, women are cared for in primary, secondary or ter-. Secondary and tertiary care is provided in (academic) hospitals, in case of medium or high risk. Women considered ‘low risk’ receive primary care and can choose to give birth in an outpatient clinic (‘poliklinisch’) or at home.

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Discussion

Conclusion