The following information was translated from the Royal Dutch Organisation of Midwives website. This is not an official translation.
This is the care which is provided before conception. This is a new area of expertise which is offered by midwives but is not yet offered by all midwives. Women can contact a midwife directly to ask for this kind of advice which encompasses two areas:
- Provide advice to improve the chances of having a healthy child
- Asses risks of possible problems or disabilities
This is the care which is provided during the pregnancy. During this period the pregnant woman visits the midwife about 10-15 times (visits increase towards the end of the pregnancy). The midwife does the following:
- she makes sure that the woman stays healthy and feels emotionally good
- she monitors the baby to make sure it is developing well
- she gives advice to make sure that nothing goes wrong during the pregnancy
- she makes sure that the woman is referred to a gynaecologist in a timely manner if this is required
- she builds a relationship of trust with the parents
Medical tests are done around the 12th week of pregnancy, which will indicate if you have anything in your blood which could potentially harm your baby, eg syphilis, hepatitis B, HIV, Rhesus factor etc. If any results are positive this can be treated during your pregnancy.
This is care which is provided during the birth. She monitors the mother and baby during and after the birth and takes any necessary measures if needed. She provides support in dealing with the contractions and gives directions during last stages of birth. If there are complications then she will seek the advice of a gynaecologist and have the woman sent to hospital if necessary.
First and Second Line Midwives
- The first line midwives works in a practice or alone, providing care for pregnant women as long as the pregnancy is normal. If the pregnancy or birth doesn’t seem normal then the midwife evaluates the nature and severity of the complication, and if special care is necessary will refer you to a hospital. A midwife provides knowledge and care related to pregnancy, birth and the first 10 days after the birth.
- The second line or ‘clinical’ midwife works in a hospital and deals with higher risk pregnancies. As long as the baby is making good progress and there is no intervention required then she will take care of you, under supervision of the gynaecologist.
- Gynaecologists provide third line midwifery and will take over when there are very special circumstances.
The Dutch Midwifery System
Home births in the Netherlands: trends 1995-2002. “TNO Kwaliteit van Leven” developed a way of national monitoring of home births. The most recent results show that an increasing amount of pregnant women in the Netherlands are cared for in the first instance by first line midwives. One of the possible reasons for this is that women go directly to the midwife without first going to her doctor. This increase didn’t lead to an increase in the amount of births with were dealt with by the first level midwives because the amount of referrals in this period also increased. The reason for that is not yet clear. What is known is that the amount of children a woman has had, her age, ethnic background and socio-economic status had an influence on the place of birth. You can read more about this in the article “Home Births in the Netherlands” (Thuisbevallen in Nederland) by Sabine Anthony, Marianne Amelink-Verburg, Pien Offerhaus en Karin van der Pal-de Bruin in the December 2005 issue of “Tijdschrift voor Verloskundigen.”
“First line where possible, second and third line where necessary.”
In the Netherlands we treat pregnancy and birth as natural events. A pregnant woman will be looked after a by first line midwife as long as that is possible. In the event of complications a woman will be immediately referred to a hospital-based gynaecologist to provide special care. The Dutch midwifery system differs dramatically from those in other western countries, where pregnancy and birth are viewed more in terms of complications for mother and baby. Pregnant women in those countries are cared for by gynaecologists and midwives almost always work in hospitals under the supervision of a gynaecologist.
The advantages of the Dutch system:
- If there are no complications then a woman can decide for herself where she would like to give birth: at home or in a hospital.
- Pregnancy and birth are treated as natural events.
- Expensive second line midwives are only used when necessary.
Choose where to give birth:
In the Netherlands a woman can give birth in different places:
- At home or in a maternity hotel (kraamhotel); 30% of women choose this option.
- In a policlinicin the hospital (returning home immediately after the birth): 20% of women choose this option.
- In a hospital (staying more than 24hrs): this is necessary for about 50% of women.
Pregnancy and Birth as Natural Events
Specialists in hospitals are constantly aware of possible complications. This is what they have trained for and this is what is expected of them. They primarily view their clients as patients. Experience tells us that this usually translates to earlier intervention in the natural process of pregnancy and birth. In countries where births take place in hospitals, more births are induced and more intervention (vacuum and forceps deliveries) is used. These sorts of measures are difficult for mother and child. Midwives are trained to make sure that pregnancy and birth are not unnecessarily handled in a medical environment, and try as much as possible to let the pregnancy and birth occur naturally. They view their clients as pregnant women with no medical complications. That is also the case for the clinical midwives who work in hospitals, who simply monitor their clients more. A midwife cares for pregnant woman before, during and after the birth of her baby. She is responsible for the health of mother and child and offers the woman and her partner information and support. A midwife is first and foremost a medical expert in her field. She cares for and monitors the mother and child during pregnancy and shortly after the birth. She has the knowledge to perform appropriate examinations, give advice and decide when a woman should be referred through to a gynaecologist or other specialist. A midwife is more than a medical expert, she is also a coach during the entire period of pregnancy. She is a source of information in all kinds of areas eg arranging a maternity nurse for after the birth. She is also a confidant, and when such a relationship is achieved this can make the difference between a positive and negative experience of the birth.
The training and competencies of the midwife are based on the ‘BIG’ (beroepsuitoefening individuele gezondheidszorg) legislation. This legislation states the skills and competencies of midwives.
Quality Register of Midwives (kwaliteitsregister verloskundigen)
This register was started in January 2006 and provides a list of midwives who work according to standards and other guidelines of their profession, and make sure that their knowledge and skills stay up to date.