Table 1 The Dutch perinatal care system

Dutch perinatal care system

Antenatal care in The Netherlands is based on the concept that pregnancy, childbirth, and the postpartum period are fundamentally physiologic processes. Obstetric risk selection is performed by community midwives or obstetricians and is based on the ‘List of Obstetric Indications’ (LOI), which specifies manifest conditions that define a low, medium, or high-risk pregnancy. An obstetrician will care for women with a high-risk pregnancy whereas a community midwife may provide care to women with a low or a medium risk.

Based on the LOI approximately 30% of all pregnant women are considered to have a low risk throughout their pregnancy and delivery. In 2015, 13.1% of all births in the Netherlands were home births. In case of an uncomplicated institutional delivery the mother will usually be discharged home within a few hours. Regardless of the risk indication based on the LOI, the community midwife will be responsible for care of the mother when discharged home during the postpartum period.

Maternity care is provided by maternity care assistants (MCAs) and will start at home, or – less frequently – in a primary care birth center, under supervision of the community midwife. Following delivery, a MCA visits and supports the family at home on a daily basis for the first eight to ten consecutive days. Initially maternity care covers six to eight hours a day but this is tapered off towards the end of the care period. If a mother is hospitalized after delivery for a longer duration, the provided care by MCAs is reduced. However, based on specific indications (see Table 2) the care provision by MCAs may be expanded.