A comparison of low-risk women’s birth outcomes and experiences in different sized midwifery practices in The Netherlands

Yvonne Fontein

Midwifery, School of Health Studies, Glasgow Caledonian University, Govan Mbeki, Room A306, Cowcaddens Road, Glasgow G4 0BA, Scotland, United Kingdom.

E-mail: yvonne.fontein@gcal.ac.uk. Tel: +44 (0)141 331 8376.

Accepted 23 September, 2009

 Abstract

To examine maternal birth outcomes and birth experiences of low-risk women in the Netherlands in different sized midwifery practices. Descriptive study was using postal questionnaires six weeks after the estimated due date. Women were recruited from urban, semi-rural and rural areas from small-sized practices (1-2 midwives), medium-sized practices (3-4 midwives) or large-sized practices (5 or more). 718 Dutch speaking women with uncomplicated pregnancies, a representative sample of women in 143 midwifery practices in the Netherlands who had given birth in the period between 20 April and 20 May 2007. Distribution of place of birth categories and intervention categories, birth experience, woman-midwife relationship and presence of own midwife after referral. Data were analyzed with Statistical Package for Social Sciences (SPSS). Women in practices with a maximum of two midwives were significantly more likely to experience lower rates of referral, interventions in general and specifically pain relief by means of pethidine, CTG registration and unplanned caesarean sections. Women with a maximum of two midwives were significantly more likely to know their midwife or midwives and were more frequently supported by their own midwife after referral in comparison to women in practices with more than two midwives. The presence of the woman’s own midwife added value to the birth experience. Women with a maximum of two midwives had higher levels of a positive birth experience than women in practices with more than two midwives. Midwifery practices with a maximum of two midwives contribute to non-interventionist birth and a positive birth experience. Awareness of the study results and further study is recommended to discuss re-organisation of care in order to achieve significant reductions on referral and interventions during childbirth and positive maternal birth experiences.

Key words: Midwifery, birth interventions, referral, practice size.