Background: In 2009, the Steering Committee for Pregnancy and Childbirth in the Netherlands recommended the implementation of continuous care during labor in order to improve perinatal outcomes. However, in current care, routine maternity caregivers are unable to provide this type of care, resulting in an implementation rate of less than 30%. Maternity care assistants (MCAs), who already play a nursing role in low risk births in the second stage of labor and in homecare during the postnatal period, might be able to fill this gap. In this study, we aim to explore the (cost) effectiveness of adding MCAs to routine first- and second-line maternity care, with the idea that these MCAs would offer continuous care to women during labor. Methods: A randomized controlled trial (RCT) will be performed comparing continuous care (CC) with care-as-usual (CAU). All women intending to have a vaginal birth, who have an understanding of the Dutch language and are > 18 years of age, will be eligible for inclusion. The intervention consists of the provision of continuous care by a trained MCA from the moment the supervising maternity caregiver establishes that labor has started. The primary outcome will be use of epidural analgesia (EA). Our secondary outcomes will be referrals from primary care to secondary care, caesarean delivery, instrumental delivery, adverse outcomes associated with epidural (fever, augmentation of labor, prolonged labor, postpartum hemorrhage, duration of postpartum stay in hospital for mother and/or newborn), women’s satisfaction with the birth experience, cost-effectiveness, and a budget impact analysis. Cost effectiveness will be calculated by QALY per prevented EA based on the utility index from the EQ-5D and the usage of healthcare services. A standardized sensitivity analysis will be carried out to quantify the outcome in addition to a budget impact analysis. In order to show a reduction from 25 to 17% in the primary outcome (alpha 0.05 and bèta 0.20), taking into account an extra 10% sample size for multi-level analysis and an attrition rate of 10%, 2 × 496 women will be needed (n = 992). Discussion: We expect that adding MCAs to the routine maternity care team will result in a decrease in the use of epidural analgesia and subsequent costs without a reduction in patient satisfaction. It will therefore be a costeffective intervention. Trial registration: Trial Registration: Netherlands Trial Register, NL8065. Registered 3 October 2019 - Retrospectively registered.
Background The caesarean delivery (CD) rate has risen in most countries over the last decades, but it remains relatively low in the Netherlands. Our objective was to analyse the trends of CD rates in various subgroups of women between 2000 and 2010, and identify the practice pattern that is attributable to the relative stability of the Dutch CD rate. Methods A total of 1,935,959 women from the nationwide Perinatal Registry of the Netherlands were included. Women were categorized into ten groups based on the modified CD classification scheme. Trends of CD rates in each group were described. Results The overall CD rate increased slightly from 14.0% in 2000–2001 to 16.7% in 2010. Fetal, early and late neonatal mortality rates decreased by 40–50% from 0.53%, 0.21%, 0.04% in 2000–2001 to 0.29%, 0.12%, 0.02% in 2010, respectively. During this period, the prevalence of non-vertex presentation decreased from 6.7% to 5.3%, even though the CD rate in this group was high. The nulliparous women with spontaneous onset of labor at term and a singleton child in vertex presentation had a CD rate of 9.9%, and 64.7% of multiparouswomen with at least one previous uterine scar and a singleton child in vertex presentation had a trial of labor and the success rate of vaginal delivery was 45.9%. Conclusions The Dutch experience indicates that external cephalic version for breech presentation, keeping the CD rate low in nulliparous women and encouraging a trial of labor in multiparous women with a previous scar, could help to keep the overall CD rate steady
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At the beginning of the twenty first century obesity entered Dutch maternity care as a ‘new illness’ challenging maternity care professionals in providing optimal care for women with higher BMI’s. International research revealed that obese women had more perinatal problems than normal weight women. However, the effect of higher BMIs on perinatal outcomes had never been studied in women eligible for midwife-led primary care at the outset of their pregnancy. In the context of the Dutch maternity care system, it was not clear if obesity should be treated as a high-risk situation always requiring obstetrician-led care or as a condition that may lead to problems that could be detected in a timely manner in midwife-led care using the usual risk assessment tools. With the increased attention on obesity in maternity care there was also increased interest in GWG. Regarding GWG in the Netherlands, the effect of insufficient or excessive GWG on perinatal outcomes had never been studied and there were no validated guidelines for GWG. A midwife’s care for the individual woman in the context of the Dutch maternity care system - characterised by ‘midwife-led care if possible, obstetrician-led care if needed’ - is hampered by the lack of national multidisciplinary consensus regarding obesity and weight gain. Obesity has not yet been included in the OIL and local protocols contain varying recommendations. To enable sound clinical decisions and to offer optimal individual care for pregnant women in the Netherlands more insights in weight and weight gain in relation to perinatal outcomes are required. With this thesis the author intends to contribute to the body of knowledge on weight and weight gain to enhance optimal midwife-led primary care for the individual woman and to guide midwives’ clinical decision-making.
Adequate gezondheidsvaardigheden van ouders zijn onontbeerlijk voor gezonde groei en ontwikkeling van hun kind en de basis voor stevig ouderschap. Bijna een derde (29%) van de Nederlandse bevolking heeft echter beperkte gezondheidsvaardigheden. Zij hebben moeite met begrijpen en toepassen van informatie van zorgverleners en regie voeren over hun gezondheid. Dit heeft negatieve invloed op gezondheidsgedrag van ouders in de zorg voor de gezondheid van henzelf en hun kinderen. Beperkte gezondheidsvaardigheden zijn complex en lastig te veranderen. Afstemmen van zorgverleners op beperkte gezondheidsvaardigheden is hierin een eerste stap. Verloskundigen en kraamverzorgenden willen beperkte gezondheidsvaardigheden beter herkennen. Tegelijk willen ze aansluitend op elkaar, optimaal afstemmen op beperkte gezondheidsvaardigheden van ouders. Onderzoeksvraag Hoe kunnen geboortezorgverleners effectief worden toegerust met bruikbare werkwijzen voor optimale afstemming op ouders met beperkte gezondheidsvaardigheden? Doelen 1. Breed gedragen en bruikbare gesprekstool om beperkte gezondheidsvaardigheden bij ouders te herkennen: de CHAT-geboortezorg. 2. Ontwerp van werkwijzen voor 3 domeinen die relevant zijn voor afstemmen van geboortezorg op beperkte gezondheidsvaardigheden van ouders: ondersteunende zorgrelaties, bevorderen van ondersteunende persoonlijke relaties van ouders en afstemmen door communicatie-op-maat. 3. Op bruikbaarheid en draagvlak getoetste en doorontwikkelde werkwijzen voor afstemming op beperkte gezondheidsvaardigheden. 4. Duurzame doorwerking en disseminatie van project- en onderzoeksresultaten in de beroepspraktijk, onderwijs en onderzoek. Met extra aandacht voor verbinding met jeugdgezondheidszorg en huisartsgeneeskunde om continuïteit van zorg na de perinatale periode te bevorderen. Methoden • Participatief Actie Onderzoek om werkwijzen te ontwikkelen in co-creatie met ouders en zorgverleners. • Most Significant Change, QQ-10 en MIDI-vragenlijsten voor kwalitatieve en kwantitatieve evaluatie- en effectmetingen. Resultaat Een interprofessioneel pakket werkwijzen voor geboortezorgverleners dat bestaat uit een breed geëvalueerde gesprekstool om beperkte gezondheidsvaardigheden bij ouders te herkennen en uit werkwijzen om de zorgverlening op hen af te stemmen binnen de domeinen (1) ondersteunende relatie met zorgverleners, (2) ondersteunende persoonlijke relaties en (3) informatievoorziening.
