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Organization and workload of midwifery care in the Netherlands.
Wiegers, T.A. Organization and workload of midwifery care in the Netherlands. European Journal of Public Health: 2006, 16(Suppl. 1) 169. Abstract. 14 th Eupha conference "Politics, Policies and /or the Public's Health", Montreux, 16-18 November 2006.
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Introduction: The organization of maternity care in the Netherlands is very different from that in the rest of Europe, with its independent, primary care midwives, its policy of continuous risk-selection, its high proportion of home births, and its professional maternity care assistants. Background: Most primary care midwives in the Netherlands are selfemployed practitioners. They provide maternity care throughout pregnancy, childbirth, and the postpartum period. Women with (an increased risk of) complications will be referred to a gynaecologist/obstetrician. Women at low risk can choose to give birth at home. In the late 1990s the workload of midwives increased strongly, endangering the possibility for women to give birth at home. Therefore, measures were taken to increase the number of practicing midwives, to reduce the workload, and to safeguard the home birth option. The purpose of this research was to provide insight in the changes occurring in the organization and workload of midwifery care following these actions. Methods: In four consecutive years (2001–2004) all midwives in a representative sample of midwifery practices kept a registration/diary of their work during three weeks continuously. They also filled out questionnaires about the practice organization, work schedules, and experiences of workload. Results: The average practice-size of a midwifery practice increased from 3.1 to 3.5 midwives. Midwives work on an average 29 h a week and are on-call for another 35 h. More than a quarter of their time is spent on non-client-related activities. Time spent on direct client care (consultations, check-ups, assistance during birth, postnatal visits) increased by ±20%. Especially the average time spent with a woman during labour and birth increased by almost a third. Conclusions: Although midwives in 2004 work on an average the same number of hours per week as they did in 2001, their workload is reduced, resulting in less clients per midwife and more time per client. (aut. ref.)
Introduction: The organization of maternity care in the Netherlands is very different from that in the rest of Europe, with its independent, primary care midwives, its policy of continuous risk-selection, its high proportion of home births, and its professional maternity care assistants. Background: Most primary care midwives in the Netherlands are selfemployed practitioners. They provide maternity care throughout pregnancy, childbirth, and the postpartum period. Women with (an increased risk of) complications will be referred to a gynaecologist/obstetrician. Women at low risk can choose to give birth at home. In the late 1990s the workload of midwives increased strongly, endangering the possibility for women to give birth at home. Therefore, measures were taken to increase the number of practicing midwives, to reduce the workload, and to safeguard the home birth option. The purpose of this research was to provide insight in the changes occurring in the organization and workload of midwifery care following these actions. Methods: In four consecutive years (2001–2004) all midwives in a representative sample of midwifery practices kept a registration/diary of their work during three weeks continuously. They also filled out questionnaires about the practice organization, work schedules, and experiences of workload. Results: The average practice-size of a midwifery practice increased from 3.1 to 3.5 midwives. Midwives work on an average 29 h a week and are on-call for another 35 h. More than a quarter of their time is spent on non-client-related activities. Time spent on direct client care (consultations, check-ups, assistance during birth, postnatal visits) increased by ±20%. Especially the average time spent with a woman during labour and birth increased by almost a third. Conclusions: Although midwives in 2004 work on an average the same number of hours per week as they did in 2001, their workload is reduced, resulting in less clients per midwife and more time per client. (aut. ref.)