Topic | Content | Characteristics | Included birth locations n = 46 (%)a |
---|---|---|---|
Philosophy | Commitment to physiological birth and facilities that contribute to the fulfilment of that philosophy | Facilities for discomfort and pain management which are allowed to be used in primary care (bath, shower, massage, nitrous oxide and/or TENS) | 46 (100) |
Facilities to encourage spontaneous pushing in non-supine positions (birth chair, birthing ball) | 42 (91) | ||
Assistance for community midwife during labour and birth by a maternity care assistant | 42 (93) | ||
Providing one-to-one support | 23 (51) | ||
Environment | Homelike | Alterable lighting / homelike atmosphere | 46 (100) |
No ‘medical’ equipment in sight | 26 (57) | ||
Responsibility for care | Community midwife | A Dutch community midwife is an independent medical professional who has full responsibility for providing care for healthy low risk women during pregnancy, childbirth and postpartum. The midwife conducts antenatal assessments, supports women giving birth at a place of their choice (at home, in a birth centre or in a hospital), and provides post-natal care up to six weeks postpartum. If medical assistance is required, the midwife will refer the women to a secondary caregiver (obstetrician or paediatrician). Community midwives in the Netherlands have a greater degree of autonomy in relation to the other medical professions than do midwives in most countries, but only as far as the low-risk population is concerned. | 46 (100) |
Population | Low risk women | Low risk women are women with a singleton pregnancy of a child in cephalic presentation who start labour spontaneously between 37 and 42 weeks and who do not have any medical or obstetric risk factors that are an indication for secondary care, such as formulated in the so-called List of Obstetric Indications [12]. They can choose where they would like to give birth (at home, in a hospital or in a birth centre). | 46 (100) |
Medium risk women | Medium risk women are low risk women with a “medium risk” indication. Due to a specific reason they are advised to give birth in hospital but still under community midwife led care. The official medium risk indications according to the so-called List of Obstetric Indications are postpartum haemorrhage or retained placenta after a previous birth. | 23 (50) | |
Management | Midwifery managed | In the organizational structure it is formally established that an independent community midwife is leading in care content and organization. | 23 (50) |
Obstetric managed | In the organizational structure the obstetrician is leading in care content and organization. | 23 (50) | |
Physical transfer in case of referral | Always needed | By wheelchair, bed, car or ambulance | 10 (22) |
Always with exceptions | By wheelchair or bed but for some urgent reasons an exception is made and the secondary caregiver (obstetrician or paediatrician) will enter the room | 13 (28) | |
Not needed | The obstetrician enters the room | 23 (50) | |
Location in relation to obstetric unit | Freestanding | Separate from the obstetric unit, in a different building than the hospital with an obstetric unit | 3 (7) |
Alongside | Separate from the obstetric unit but in a hospital with an obstetric unit | 17 (37) | |
On-site | On the same ward as the obstetric unit | 26 (57) |