Corona virus and being pregnant

Zwanger Corona Zwolle

 

Commonly asked questions about the corona virus

Becoming pregnant, being pregnant, giving birth and the upcoming parenthood might be challenging if you don’t speak Dutch. Birth Verloskundigen is a midwife practice in Stadshagen Zwolle that will provide you with

Verloskundige Stdshagen

Verloskundige praktijk Stadshagen Zwolle

guidance during the pregnancy, giving the birth and the maternity period. We can also provide information on planning to conceive, how to plan your birth control and birth control prescription (insertion of birth control devices, such as spiral ect.)

Birth Verloskundigen is a small, personal, committed and dedicated midwife practice that delivers a full care model for parents and children. We offer you professional midwifery care from a responsible and efficient perspective by working closely together with other disciplines. We have the possibility to provide you with longer and more frequent checkups than usual in a Dutch practice, so there will be enough time for all your wishes and questions.

 

The list of frequently asked questions about the Corona virus, especially for pregnant women, has been drawn up by the KNOV (Royal Dutch Organization of Midwives) together with the NVOG (The Dutch Association for Obstetrics and Gynecology and the NVK (Dutch Association for Pediatrics). If you have any questions, you can always contact your midwife.

Am I infected with the Coronavirus?

At https://lci.rivm.nl/richtlijnen/covid-19 you can see if there is an indication to do further tests for the COVID-19 virus. If there is any doubt, please contact your doctor by telephone. If you are considering to visit your midwifery provider for this, first contact them by telephone for advice.

Is an infection with COVID-19 more serious for a pregnant woman?

Based on limited data, there is no evidence that pregnant women are more susceptible to be infected by COVID-19. It is still uncertain whether the course of an infection with COVID-19 is different from that of women who are not pregnant. From other viral infections, we know that a woman is more likely to have lung problems if she is pregnant.

Can the unborn baby become infected during pregnancy or delivery?

So far, no direct transmission (vertical transmission) of the COVID-19 virus from mother to child has been described during pregnancy or delivery. The virus has so far not been detected in amniotic fluid, umbilical cord blood, the throat of a newborn or in breastfeeding. Contamination is possible from mother to child via the normal human-to-human route (horizontal transmission).

Can I miscarry from COVID-19?

Based on limited data, there is no evidence that women infected with COVID-19 are more likely to have a miscarriage or pregnancy loss. There may be slightly more preterm birth, but it is not yet clear whether this is spontaneous preterm birth or whether a pregnancy has ended prematurely on medical grounds.

I now have an infection with COVID-19 and am in home isolation, will my appointment with the midwife or gynecologist be continued?

Consult with your midwife on what to do in this particular case.

I now have an infection with COVID-19, can I give birth at home?

Based on limited data, we recommend a hospital delivery during the active infection with surveillance (cardiotocogram, CTG) of the fetus. If the infection was> 14 days ago, this advice will be canceled.

Can I breastfeed if I have an infection with COVID-19?

There is no contraindication for breastfeeding. COVID-19 has not been detected in breast milk. It is recommended to breastfeed with a mouth mask and to observe hygiene measures (wash hands before touching the baby or breasts, use your own breast pump or bottle and clean the breast pump well after use). Because it is possible to infect the baby in your vicinity, it is worth considering having (pumped) food given by a healthy person.

I have been cured from an infection with COVID-19, am I now under the control of a gynecologist?

In principle, a past infection with COVID-19 is not a medical indication. For the time being, however, it is recommended to have growth ultrasounds made.

Birth Verloskundigen

Birth Verloskundigen is a small, personal, committed and dedicated midwife practice that delivers a full care model for parents and child. We offer you professional midwifery care from a responsible and efficient perspective by working closely together with other disciplines. We have the possibility to provide you with longer and more frequent checkups than usual in a Dutch practice. By doing this, there will be enough time for all your wishes and questions.

Stadshagen verloskundige praktijk

Verloskundige Stadshagen

Therefore, we provide you with an English speaking midwife, flexible consultation hours, ultrasounds, home visits, continuous monitoring during the pregnancy. We provide delivery at home and in the hospital, cooperation with the gynecologists in the region. All midwives are registered in the quality register for midwives. We have contracts with all major healthcare insurance companies, post-natal care, preconception consultation and birth control consultation.

Because it is not about us, but about you. It’s about your pregnancy, you are giving birth and it’s your child. We inform, facilitate and check.

You are welcome for a free consultation at our practice in Stadshagen Zwolle, or we can visit you on-site.

Are you interested or do you have any questions? Please contact us by sending an email to info@birth-verloskundigen.nl or call us at +31 6 15 15 80 52.

Hopefully see you seen!
Birth Verloskundigen

www: www.birth-verloskundigen.nl

email: info@birth-verloskundigen.nl

Verloskundige Zwolle

Verloskundige Zwolle

Zwolle Midwife: Three stages of pregnancy

Stadshagen verloskundigen

The three stages of pregnancy

Becoming pregnant, being pregnant, giving birth and the upcoming parenthood might be challenging if you don’t speak Dutch. Birth Verloskundigen is a midwife practice in Stadshagen Zwolle that will provide you with

Verloskundige Stdshagen

Verloskundige praktijk Stadshagen Zwolle

guidance during the pregnancy, giving the birth and the maternity period. We can also provide information on planning to conceive, how to plan your birth control and birth control prescription (insertion of birth control devices, such as spiral ect.)

Birth Verloskundigen is a small, personal, committed and dedicated midwife practice that delivers a full care model for parents and children. We offer you professional midwifery care from a responsible and efficient perspective by working closely together with other disciplines. We have the possibility to provide you with longer and more frequent checkups than usual in a Dutch practice, so there will be enough time for all your wishes and questions.

 

 

Midwife Zwolle Stages of pregnancy

The average pregnancy period takes about nine months and a lot will happen during this period. In three blogs we will describe this period. This first blog is a summary of the three phases of your pregnancy. In the second blog we will describe the growth and how the baby is developing during this period and the last blog will be about what you can expect from Birth Verloskundigen during this period.

The pregnancy period can be divided into three phases, the three trimesters. The average duration of a pregnancy will take around nine months. It hardly ever takes exactly nine months. With one it concerns a shorter period, with the other it takes a little longer. This differs from person to person. The period may also differ per pregnancy. Yet a pregnancy always consists of the same phases. In general, the period that you carry the baby in your belly is divided into three different phases, also trimesters.

This article provides you with an overview of the 3 trimesters.

The first trimester

Midwife Zwolle first trimester

The first trimester takes the first 13 weeks of your pregnancy staring to count from the first day of your last normal period.

During this period the baby develops in the belly. During this phase the embryo develops more and more. For example, the foundation is laid for the nervous system, intestines, eyes, skin and lungs. We can therefore state that the first phase of pregnancy is a crucial phase.

Also, during the first trimester your body will be subject to many changes. These changes can trigger symptoms even in the very first weeks of pregnancy.

Changes may include:

  • Your period is stoppingVerloskundige Zwolle
  • Extreme tiredness
  • Tender, swollen breasts. Your nipples might also stick out.
  • Upset stomach with or without throwing up (morning sickness)
  • Cravings or distaste for certain foods
  • Mood swings
  • Constipation (trouble having bowel movements)
  • Need to pass urine more often
  • Headache
  • Heartburn
  • Weight gain or loss

As your body changes, you might need to make changes to your daily routine, such as going to bed earlier or eating frequent, small meals. Fortunately, most of these discomforts will go away as your pregnancy progresses. And some women might not feel any discomfort at all! If you have been pregnant before, you might feel differently this time around. Just as each woman is different, so is each pregnancy.

As soon as you know that you are pregnant, adjust your lifestyle immediately. For example, make sure you eat the right food. This concerns food that is good for you, but of course also for the baby that grows in your belly. Are you a drinker and do you smoke regularly? Then you absolutely must stop this at this stage. These resources can have adverse consequences for the development of your child.

The second trimester

Midwife Zwolle second trimester

In the second phase the baby will grow a lot. It will go from around 6.9 cm to around 36.8 cm. His weight also rises, from 32.5 grams to 940 grams. The development of the baby will also accelerate during this period. The baby trains the muscles, practices breathing, sucking and swallowing. During the second phase, the senses also work, from the womb it is possible to hear your voice and later even recognize it and the baby can also notice the light through your belly. The further the baby develops, the more the senses will work. During the second phase, the face becomes more human and so does the behavior. The baby can get the hiccups, can yawn and also thumbs. The baby is almost finished from the outside, only the inside will have to grow a lot.

In general, most women consider the second trimester easier than the first. But it is just as important to stay informed about your pregnancy during these months.

You might notice that symptoms like nausea and fatigue are going away. But other new, more noticeable changes to your body are now happening. Your abdomen will expand as the baby continues to grow. And before this trimester is over, you will feel your baby beginning to move!

As your body changes to make room for your growing baby, you may have:

  • Body aches, such as back, abdomen, groin, or thigh painStadshagen verloskundige
  • Stretch marks on your abdomen, breasts, thighs, or buttocks
  • Darkening of the skin around your nipples
  • A line on the skin running from belly button to pubic hairline
  • Patches of darker skin, usually over the cheeks, forehead, nose, or upper lip. Patches often match on both sides of the face. This is sometimes called the mask of pregnancy.
  • Numb or tingling hands, called carpal tunnel syndrome
  • Itching on the abdomen, palms, and soles of the feet. (Call your doctor if you have nausea, loss of appetite, vomiting, jaundice or fatigue combined with itching. These can be signs of a serious liver problem.)
  • Swelling of the ankles, fingers, and face.

The third trimester

Midwife Zwolle third trimester

During the third phase of the 3 phases of pregnancy, the baby grows approximately 14 cm, the weight will be doubled more than 4 times. It will be around 3400 grams. At the start of this phase the baby can open its eyes and it can also blink.

The third trimester is the final stretch of pregnancy. Physical effects will reach an all-time high, as both the woman and child’s bodies prepare for birth. Some of the same discomforts you had in your second trimester will continue. Plus, many women find breathing difficult and notice they have to go to the bathroom even more often. This is because the baby is getting bigger and it is putting more pressure on your organs.

 

Eyelashes have formed and the fetus will be able to open its eyes; the nervous system is strong enough to control the body’s temperature and also rhythmic breathing. The baby starts swallowing, moving, sucking on the fingers and getting the hiccups. All organs such as the kidneys and liver are fully developed at the end of the third phase. The cartilage changes to bone, and the skull consists of loose plates. These loose plates can slide over each other during delivery. At the end of the third phase, and therefore also the pregnancy, the uterus will become tight for the baby. The baby will therefore adopt a comfortable lying position that the baby likes. When the 37 weeks are over, the baby is “ready to go.” The birth can start any time, it is of course also possible that the baby wants to stay with you until week 42.

Some new body changes you might notice in the third trimester include:

  • Shortness of breathVerloskundige Stadshagen
  • Heartburn
  • Swelling of the ankles, fingers, and face.
  •  Hemorrhoids
  • Tender breasts, which may leak a watery pre-milk called colostrum (kuh-LOSS-struhm)
  • Your belly button may stick out
  • Trouble sleeping
  • The baby “dropping”, or moving lower in your abdomen
  • Contractions, which can be a sign of real or false labor

As you near your due date, your cervix becomes thinner and softer (called effacing). This is a normal, natural process that helps the birth canal (vagina) to open during the birthing process. Your midwife will check your progress with a vaginal exam as you near your due date. Your breasts may also feel fuller and heavier, to prepare for breastfeeding, and you will start to feel contractions soon. Finally, you can feel Braxton Hicks contractions at any time during the third trimester. Unlike real contractions, these irregular, mild tightenings of the uterus may go away if you simply walk around. Still, if you aren’t sure what you’re experiencing, call Birth Verloskundigen in Zwolle Stadshagen

Birth Verloskundigen

Birth Verloskundigen is a small, personal, committed and dedicated midwife practice that delivers a full care model for parents and child. We offer you professional midwifery care from a responsible and efficient perspective by working closely together with other disciplines. We have the possibility to provide you with longer and more frequent checkups than usual in a Dutch practice. By doing this, there will be enough time for all your wishes and questions.

Stadshagen verloskundige praktijk

Verloskundige Stadshagen

Therefore, we provide you with an English, German, French or Arabic speaking midwife, flexible consultation hours, ultrasounds, home visits, continuous monitoring during the pregnancy. We provide delivery at home and in the hospital, cooperation with the gynecologists in the region. All midwives are registered in the quality register for midwives. We have contracts with all major healthcare insurance companies, post-natal care, preconception consultation and birth control consultation.

Because it is not about us, but about you. It’s about your pregnancy, you are giving birth and it’s your child. We inform, facilitate and check.

You are welcome for a free consultation at our practice in Stadshagen Zwolle, or we can visit you on-site.

Are you interested or do you have any questions? Please contact us by sending an email to info@birth-verloskundigen.nl or call us at +31 6 15 15 80 52.

Hopefully see you seen!
Birth Verloskundigen

www: www.birth-verloskundigen.nl

email: info@birth-verloskundigen.nl

Verloskundige Zwolle

Verloskundige Zwolle

Stadshagen Midwife: Maternity leave for partners in the Netherlands

Verloskundige Stadshagen

The maternity partner leave program in the Netherlands

Becoming pregnant, being pregnant, giving birth and the upcoming parenthood might be challenging if you don’t speak Dutch. Birth Verloskundigen is a midwife practice in Stadshagen Zwolle that will provide you with

Verloskundige Stdshagen

Verloskundige praktijk Stadshagen Zwolle

guidance during the pregnancy, giving the birth and the maternity period. We can also provide information on planning to conceive, how to plan your birth control and birth control prescription (insertion of birth control devices, such as spiral ect.)

Birth Verloskundigen is a small, personal, committed and dedicated midwife practice that delivers a full care model for parents and children. We offer you professional midwifery care from a responsible and efficient perspective by working closely together with other disciplines. We have the possibility to provide you with longer and more frequent checkups than usual in a Dutch practice, so there will be enough time for all your wishes and questions.

 

The partner leave program of the Netherlands is not always easy to understand for non-Dutch speaking people. Even for Dutch Speaking people it’s sometimes hard to get.

As of the 1st of July 2020, the current Dutch law with regards to the partner leave program will change. Even most of the Dutch partners are not aware of the new applicable law as of the first of July 2020.

The existing arrangement as of the first of January 2019

Since the 1st of January 2019, partners of women who have given birth are entitled to the number of working hours per week at 100% of the wage. The employee can take these leave days at his own discretion. But must do this within 4 weeks after the birth of the child.

Example: the partner is working 4 days, 8 hours per day. The partner is entitled to have 8 X 4 = 32 hours, to be taken in the first 4 weeks after the delivery at his own discretion. The employer will continue to pay the salary in full during this leave.

Maternity leave as of the 1st of July 2020

As of the 1st of July 2020, the partners may take another 5 weeks of additional birth leave in the first half year, after the delivery at 70% of their wages.

The employee must take these leave weeks within 6 months after the birth of the child. However, one of the conditions is that an employee first takes up the birth leave of once the number of working hours per week.

An employee must also request the leave in whole weeks. In consultation with the employer, the employee can spread the additional leave over a period longer than 5 weeks. It is also possible to take additional birth leave for less than 5 weeks.

Is your child born on or after 1 July 2020? Then your partner will be entitled to supplementary birth leave and the benefit.

Midwife Zwolle Maternity Leave

Maternity Leave as of the 1st of July 2020

Partners bounding with their newborn

Research suggests that fathers who are hand-on early and throughout their babies’ early years will be less stressed, and the children benefit too, so that’s why every partner should consider to take the benefits of the maternity leave facilities.

Whether they deserve it or not, new dads can get a bad press for failing to be “hands-on” with their new son or daughter. But now a growing body of research suggests that the sooner fathers starting bonding with their baby, the brighter the future for the whole family.

Partners are given the space to be a father. If they find that they can very well take care of their child alone, this increases the self-confidence in their paternity.

More information can be obtained at the official site of the Dutch Government at: https://www.rijksoverheid.nl/onderwerpen/geboorteverlof-en-partnerverlof/plannen-met-geboorteverlof-voor-partners

How is the arrangement in the Netherlands compared to other countries?

Sweden, Norway, Iceland, Estonia and Portugal offer the best family-friendly policies among 31 rich countries with available data, according to a new UNICEF report. Switzerland, Greece, Cyprus, United Kingdom and Ireland rank the lowest.

Produced by UNICEF’s Office of Research – Innocenti the report ranks countries across the Organisation for Economic Co-operation and Development (OECD) and European Union (EU) based on their national family-friendly policies. These policies include the duration of parental leave at full pay equivalent, and childcare services for children aged between 0-6 years old.

Looking at the position of the Netherlands  with regards to parental leave for partners, there is still a lot of work to be done.

Maternity Leave

Source: https://www.unicef-irc.org/family-friendly#sectionDownload

The report also finds that there is a significant lack of paid paternity available to fathers. However, even when fathers are offered paid leave, many do not to take it. In Japan, the only country that offers at least six months at full pay for fathers, only 1 in 20 fathers took paid leave in 2017.

Birth Verloskundigen

Birth Verloskundigen is a small, personal, committed and dedicated midwife practice that delivers a full care model for parents and child. We offer you professional midwifery care from a responsible and efficient perspective by working closely together with other disciplines. We have the possibility to provide you with longer and more frequent checkups than usual in a Dutch practice. By doing this, there will be enough time for all your wishes and questions.

Stadshagen verloskundige praktijk

Verloskundige Stadshagen

 

Therefore, we provide you with an English, German, French or Arabic speaking midwife, flexible consultation hours, ultrasounds, home visits, continuous monitoring during the pregnancy. We provide delivery at home and in the hospital, cooperation with the gynecologists in the region. All midwives are registered in the quality register for midwives. We have contracts with all major healthcare insurance companies, post-natal care, preconception consultation and birth control consultation.

Because it is not about us, but about you. It’s about your pregnancy, you are giving birth and it’s your child. We inform, facilitate and check.

You are welcome for a free consultation at our practice in Stadshagen Zwolle, or we can visit you on-site.

Are you interested or do you have any questions? Please contact us by sending an email to info@birth-verloskundigen.nl or call us at +31 6 15 15 80 52.

Hopefully see you seen!
Birth Verloskundigen

www: www.birth-verloskundigen.nl

email: info@birth-verloskundigen.nl

Verloskundige Zwolle

Verloskundige Zwolle

Top ten common words during your pregnancy

Terminology during your pregnancy

Becoming pregnant, being pregnant, giving birth and the upcoming parenthood might be challenging if you don’t speak Verloskundige StadshagenDutch. Birth Verloskundigen is a midwife practice in Stadshagen Zwolle that will provide you with guidance during the pregnancy, giving the birth and the maternity period. We can also provide information on planning to conceive, how to plan your birth control and birth control prescription (insertion of birth control devices, such as spiral ect.)
Birth Verloskundigen is a small, personal, committed and dedicated midwife practice that delivers a full care model for parents and children. We offer you professional midwifery care from a responsible and efficient perspective by working closely together with other disciplines. We have the possibility to provide you with longer and more frequent checkups than usual in a Dutch practice, so there will be enough time for all your wishes and questions.

During your pregnancy you might be confronted with all kinds of terminology and wordings you never heard before.
As to help you with this terminology, we have selected 10 commonly used words and explained them below.

Breast engorgement or Stowage (Dutch: Stuwing)

Breast engorgement happens commonly in the early days and weeks of breastfeeding. Once your baby is born, your breasts

Midwife Zwolle

Breast feeding during pregnancy

get a signal to start full milk production. If your milk production starts after a few days, you may suffer from congestion.Breast engorgement /Stowage can be recognized by warm, painful and / or tense breasts. The reason is, that there is still a kind of disbalance between “demand” of your baby and your breastmilk “supply” on the other side.

Colostrum (Dutch: Colostrum)

Colostrum is the first breast milk that your breasts produce during pregnancy and in the first few days after the birth of a child. This is the first stage of breast milk production. Colostrum is packed with antibodies to optimally protect your baby against infections immediately after birth. Colostrum is also called “gold liquid”.

 

Dilation (Dutch: Ontsluiting)

Dilation is the phase of labour in which the cervix opens. In most healthy, full-term pregnancies, the cervix remains tightly closed until late in the third trimester. At this point, your baby starts to engage in the pelvis, putting pressure on the cervix and causing it to open up, or dilate, in preparation for labor. Once labor begins, contractions will cause your cervix to dilate fully, allowing your baby to enter the birth canal and, ultimately, be born.Usually, the last centimeters dilations happens faster than at the beginning of delation. Complete dilation is when the dilation is ten centimeters, during the pushing (second stage), the baby can further descend into the birth canal (vagina).

Fundus (Dutch: Fundus)

The upper edge of the Uterus is called the Fundus.During your pregnancy, the growth of your uterus is a good indication of the growth of your baby. When you go for a checkup, your midwife checks how your uterus grows by measuring/feeling the position of the upper edge relative to the pubic bone and the navel. This is called fundus height.

Membrane stripping or membrane sweeping (Dutch: Strippen)

The midwife might “strip” your membranes to increase the chance of giving birth naturally, usually this is done from 41 weeks.Stripping the membranes is a way to induce labor. It involves your midwife sweeping their (gloved) finger between the thin membranes of the amniotic sac in your uterus. First, she will feel through internal vaginal examination whether the cervix is ​​already flexible and whether there is already dilation. If that is the case, your membranes can be stripped. This releases hormones (prostaglandins) that can start the birth.

Neonate (Dutch: Neonaat)

A Neonate is the term used for a newborn baby aged between 1 and 28 days.

Placenta (Dutch: Placenta)

The placenta (also known as the afterbirth or mother’s cake) is a very important organ, it ensures that the pregnancy remains instant and supplies your baby with nutrition and oxygen. After the birth of your child, the placenta has yet to come. The uterus needs to contract to release the placenta from the uterine wall. The obstetrician or midwife checks whether the placenta is loose, if that is the case, you are asked to press again so that it is born. The placenta, membranes and umbilical cord are always carefully checked to see if they are complete.

Pushing (Dutch: Uitdrijving)

After the Dilation phase, the next stage starts: the expulsion.During the expulsion stage, contractions reach maximum intensity and push the fetus out of the uterus, through the cervix, and down the birth canal. Delivery, or birth of the fetus, is the arrival of the fetus into the outside world.

Verloskundige ZwolleOxytocin (Dutch: Oxytocine)

Oxytocin is known as the “cuddle hormone,” but that simplistic moniker glosses over the complex role this hormone plays in social interactions and bonding.Oxytocin plays a major role before, during and after your pregnancy. It is produced by a small part of your brain, called hypothalamus. It causes fertilization, the contractions during birth, and milk production after birth. After the birth, your hormone balance changes permanently. Women who gave birth have higher oxytocin levels, compared to other women. This helps forming a good relationship between you and your baby.

 

 

Vaginal Examination (Dutch: Toucheren)

Vaginal examination is the internal examination that is done by the midwife, when the delivery has (probably) started. He or she puts two fingers in your vagina to check whether the cervix has already softened and to see how far the disclosure has progressed.Midwifes gauge cervical dilation by feeling the cervical opening with two fingers. They place their two fingers on either side of the cervical opening and estimate how far apart their fingers are. They can’t see the cervix itself during the exam since the cervix is located at the back of the vagina.

Birth Verloskundigen

Birth Verloskundigen is a small, personal, committed and dedicated midwife practice that delivers a full care model for parents and child. We offer you professional midwifery care from a responsible and efficient perspective by working closely together with other disciplines. We have the possibility to provide you with longer and more frequent checkups than usual in a Dutch practice. By doing this, there will be enough time for all your wishes and questions.

Verloskundige Stadshagen Zwolle

Therefore, we provide you with an English, German, French or Arabic speaking midwife, flexible consultation hours, ultrasounds, home visits, continuous monitoring during the pregnancy. We provide delivery at home and in the hospital, cooperation with the gynecologists in the region. All midwives are registered in the quality register for midwives. We have contracts with all major healthcare insurance companies, post-natal care, preconception consultation and birth control consultation.

Because it is not about us, but about you. It’s about your pregnancy, you are giving birth and it’s your child. We inform, facilitate and check.

You are welcome for a free consultation at our practice in Stadshagen Zwolle, or we can visit you on-site.

Are you interested or do you have any questions? Please contact us by sending an email to info@birth-verloskundigen.nl or call us at +31 6 15 15 80 52.

Hopefully see you seen!
Birth Verloskundigen

www: www.birth-verloskundigen.nl

email: info@birth-verloskundigen.nl

10 veelvoorkomende woorden tijdens de zwangerschap 🤰Tijdens de zwangerschap en de bevalling komen er veel woorden…

Gepostet von birth-verloskundigen am Dienstag, 12. November 2019

Verloskundige Zwolle

Verloskundige Zwolle

After delivering, its time for selecting your Child Care Centre

Selecting your Childcare

It’s time! The time of weekday afternoon naps with your baby is almost over: you go back to work and your little one goes to daycare for the first time. It is quite a challenge for every parent to find the right childcare.

Which requirements must they meet? And what should you pay attention to? Read all about the childcare requirements here on the website of the government 👉 https://www.rijksoverheid.nl/onderwerpen/kinderopvang/kwaliteitseisen-kinderopvang-en-peuterspeelzalen.

The text below is a free translation of the information provided on the governmental website: https://www.rijksoverheid.nl/onderwerpen/kinderopvang/kwaliteitseisen-kinderopvang-en-peuterspeelzalen.

Quality requirements for childcare

Good childcare is very important. Children need to feel safe and have the space to develop. The central government has therefore drawn up quality requirements that childcare organizations must adhere too. These requirements are part of the Innovation and Quality of Childcare Act (IKK).

Development is central

The development of children is important. It lays a foundation for the rest of their lives. Childcare organizations must therefore exchange development information with the child’s school. This can only happen after the parents have given written permission for this.

A mentor for every child

Every child in childcare receives a mentor. Also, the children who go to the day care on a flexible day care basis. The mentor is a pedagogical employee from the child’s group. The mentor stimulates the child’s development. For example, by setting goals. Are there specificities in the development of the child? Then the mentor refers to the parents for further help.

Number of pedagogical employees per child

The group size and group composition must be in the correct proportion to the number of pedagogical employees. The maximum number of babies of 0 years per pedagogical employee has decreased since 1 January 2019. That is now 1 pedagogical employee for 3 zero-year children. Previously it was 1 pedagogical employee at 4 zero-year children. As a result, the pedagogical employee has more time and attention for children in the first year of life.

For children as of the age of 7 years in an out-of-school care (BSO), the maximum number of children per pedagogical employee has increased. From 1 in 10 children to 1 pedagogical employee to 12 children. This change took effect on January 1, 2019.

Volunteers do not count as pedagogical staff members in the calculation of the maximum number of children per pedagogical staff member.

Permanent employees for zero-year-olds

Zero-year-olds must have a minimum of 2 permanent employees who guide them. This is called the fixed-face criterion. A permanent employee knows how a baby develops, what makes the child stressed and what he needs. The fixed-face criterion does not apply to after-school care.

Coaching by a pedagogical policy officer

Every childcare must have a pedagogical policy officer from January 1, 2019. The pedagogical policy officer coaches the pedagogical staff in their daily activities. The coaching must take place at least annually. The pedagogical policy officer also deals with pedagogical policy. For example, how pedagogical employees challenge children to learn new skills.

Training and development of pedagogical employees

The childcare organization must have a training plan for the education and development of pedagogical staff. There is a limitation for the use of trainees and employees who do not yet meet the training requirements. That way there is enough time and capacity to guide them.

From 1 January 2023, all pedagogical staff working with babies must receive specific training. Raid forces and pedagogical employees who work on baby groups on a temporary basis must also meet this qualification requirement.

Dutch language

The requirements for the minimum language level for professionals come into effect on January 1, 2023. They must have a good command of the Dutch language.

Safety

Children in childcare are vulnerable. Certainly, if they are so young that they cannot yet express themselves verbally. The central government is therefore taking measures to improve childcare safety.

Checking quality requirements

The GGD checks whether childcare organizations meet the statutory quality requirements. They do this on behalf of the municipality, based on the model report day care. Municipalities must take enforcement action if organizations do not meet the requirements. This can be done, for example, by issuing a warning or imposing a fine. The Education Inspectorate annually investigates whether municipalities perform their legal duties in the field of childcare.

In the National Childcare Register (LRK) you will find a summary of GGD inspection results per childcare location.

This blog article is based on: https://www.rijksoverheid.nl/onderwerpen/kinderopvang/kwaliteitseisen-kinderopvang-en-peuterspeelzalen.

In case you would like to receive more information, please contact us at: www.birth-verloskundigen.nl/contact

 

Het is zo ver! De tijd van doordeweekse middagdutjes met je baby is bijna voorbij: jij gaat weer aan het werk en je…

Gepostet von birth-verloskundigen am Donnerstag, 5. September 2019

 

Heat during pregnancy

WHAT A HEAT

A pregnant body needs to put a little more effort in getting rid of the heat of the summer sun.

Via the link you will find a number of tips 💡. These tips will help you to have as little trouble with the heat as possible. https://deverloskundige.nl/nieuws/artikel/het-is-zomer-tips-voor-zwangere-vrouwen-voor-de-hete-zomerdagen/379

For further questions, please don’t hesitate to contact us.

The role of the partner during delivery

As a partner of a pregnant woman you sometimes have the impression that you are there  pure as decoration during the birth. But you do play a role!

The role of a birth partner is to give you practical and emotional support when you’re in labour.

Some activities for the partner:

  • Be a Coach; This is the most hands-on role. You’ll help your partner relax and push, cheer her on, and be her advocate with the hospital staff.
  • Maintain the atmosphere in the room (light, music, temperature)
  • Radiate rest and relaxation and help the childbirth to relax To interpret the wishes of the child
  • Massage; for example of the back and feet
  • If you want to be a part of the game, but don’t want to coach, be a teammate; You provide encouragement and help out when your partner asks

If you have questions about this, you can of course always discuss it with the midwife.

www.birth-verloskundigen.nl/contact

The experiences of clients with Dutch obstetric and neonatal healthcare

Abstract

Client experiences are an important aspect of obstetric and neonatal healthcare. In the Netherlands, various healthcare professionals guide pregnant women and new mothers. Different healthcare professionals providing guidance and treatment can lead to discontinuity of care. This can negatively influence client satisfaction and therefore quality of care. This thesis, and literature, suggests that women transferred during childbirth are less satisfied with the care provision and the quality of care than those not transferred. Dissatisfaction with the care provided during pregnancy, childbirth and the postpartum period can have serious adverse effects on the physical, mental, and physiological state of the client. As an indicator of the quality of the care, client experiences and satisfaction are becoming more important. Client experiences and satisfaction provide in-depth information about how the obstetric and neonatal healthcare system performs, which in turn can be used to improve the quality of care. Therefore, Dutch obstetric and neonatal healthcare professionals work towards maintaining and improving client experiences and satisfaction. The value of this study’s mixed methods approach is that the results of the different sub-studies complement one another and endeavor to provide an in-depth examination of the research aim. The aim of this thesis is to investigate clients’ and professionals’ experiences with Dutch obstetric and neonatal healthcare by highlighting their experiences with transfers of care.

The experiences of clients with Dutch obstetric and neonatal healthcare, included in several chapters in this thesis, showed that, in general, Dutch mothers are very satisfied with the provided healthcare during their pregnancy, childbirth and postpartum period. We gained a better understanding about how transfers of care can influence the satisfaction with obstetric and neonatal healthcare in women with uncomplicated pregnancies. Namely, women who experienced a transfer during childbirth were less satisfied with the provided healthcare than women who did not experiences a transfer of care. Just like the clients, professionals were in general satisfied with how they transferred their clients and how colleagues transferred their clients to them. Continuity of care benefits from a situation where professionals know each other in person and trust each other’s capabilities. Logically, obstetric and neonatal healthcare professionals want their clients to look back on their healthcare experiences as positively as possible. This is of course idealistic, but taking into account the long-term effects associated with negative experiences, this is definitely something to work towards.

Research output: ThesisPhD Thesis – Research UT, graduation UTAcademic

The article can be obtained from:

An exploration of Dutch midwives’ opinion on the implementation of the new policy to enhance the care of pregnant asylum seekers

An exploration of Dutch midwives’ opinion on the implementation of the new policy to enhance the care of pregnant asylum seekers

Moi Thuk Shung e/v Doergaram Tewarie Jenny Rina

MMB722342-15-AB

This dissertation is submitted in partial fulfilment of the requirements for the degree of Master of Science Midwifery from Glasgow Caledonian University

August 2016 of Submission

“This dissertation is my own original work and has not been submitted elsewhere in fulfilment of the requirements of this or any other award. An exact copy of this piece of work has also been submitted to the Dissertation Turnitin site on GCU Learn”        

Abstract

Background In February 2014 the Health Care Inspectorate (2014) in the Netherlands announced that in order to improve pregnancy care for pregnant asylum seekers and their children, policies and guidelines had to be adjusted. A literature review of the topic identified a deficit in information relating to the opinions of Dutch midwives using the modified policies and protocols for pregnant asylum seekers in the Netherlands.

Aim This study aims to explore Dutch midwives’ opinion in providing health care to pregnant asylum seekers due to the implemented policies and guidelines.

Methods Purposive sampling from contacted midwifery practitioners and a cross-sectional descriptive approach was used to explore midwives’ opinion in relation to the applied policies and guidelines in providing care to pregnant asylum seekers. Survey Monkey was used to deliver the questionnaires online to the respondents and obtain respondents’ answers to the questionnaires.

Results The opinions of the Dutch midwives concerning the communication processes, the transfer processes, cultural diversity, language barriers and the use of a case manager in providing care to pregnant asylum seekers were largely positive. Contradictions were found in the responses regarding the use of an interpreter service. Conclusively the study revealed that the responders do not seem to make use of the interpreter services.

Conclusion The council of the European Union in Directive 2003/9 / EC of the Council of 27 January 2003 has laid down minimum standards for the reception of asylum seekers. Health care for pregnant asylum seekers was improved by adjusting the policies and guidelines of the mandatory reception regulations for dignified standard of living conditions in the Netherlands. In 2014 The Health Care Inspectorate conducted an extensive serial nationwide multi-annual study of prenatal, natal and postnatal care. This study aims to find out whether there are significant improvements to be made by modifying the maternity policies and guidelines. This is done by exploring Dutch midwives’ opinion on the implementation of the new policy to enhance the care of pregnant asylum seekers.

Acknowledgements

This study was supported with funding completely by the author who undertook the study. This study was self-funded by the author.

The author reports no conflicts of interest in this work.

This Research Dissertation owes much to the people who guided and supported me along the way. Thanks to:

Family Doergaram Tewarie, support and patience,
Mrs. Catriona Hendry, midwifery lecturer at Glasgow Caledonian University,
Mrs. Dr. Marion Welsh, senior lecturer in Research Methods teaching at Glasgow Caledonian University,
Mrs. Linda Evans, bilingual support,
Mr. Herman Braat, de Datawerkplaats: statistics support.

Introduction

There is growing international attention on migrant health, reflecting the recognition of the need for health systems to adapt to the increasingly diverse populations (WHO, 1978). That is not surprising, according to the United Nations High Commissioner for Refugees (UNHCR), head of the refugee agency of the United Nations. The UNHCR reveals that the Member States of the European Union (EU) registered 570,800 asylum claims in 2014, a 44 per cent increase compared with 2013 (396,700). The EU states together accounted for 80 per cent of all new asylum claims in Europe. The Netherlands accounted for five per cent (29,890) of the EU registered asylum claims in 2014 and four per cent (17,189) in 2013 (UNHCR, 2016). In 2007 the EU Presidency made migrant health a priority, resulting in a statement by the EU Council of Ministers, while further support came from the Council of Europe in the 2007 Bratislava Declaration on Health, Human Rights and Migration and the 2008 World Health Assembly resolution on the Health of Migrants (Rechel, 2011). The study by Rechel et al. 2012 points out that the health data of migrants are crucial for providing appropriate and accessible health service to this expanding group of people. There seems to be a lack of information on the health of migrants, which limits possibilities for monitoring and improving migrant health. Yet, the European Parliament and the Council of the European Union who announced a programme of community action on health monitoring in 2008 the Euro-Peristat (Peristat) revealed the first European health report (European Communities, 2001; Peristat 2008). The Peristat 2008 reveals health indicators to monitor the quality of pregnancy care in Europe; for a high-income industrial country, the Netherlands stands out with regard to adverse pregnancy outcomes in comparison with the other European countries as a result of the Peristat reports. Moreover, two cohort studies in the Netherlands provided more detailed information about the poor performance according to the Peristat report (Troe et al., 2007; Goedhart et al., 2008). Both studies revealed that adverse pregnancy outcomes in the Netherlands were mainly observed among the ethnic minority groups, with an emphasis on the subgroup of asylum seekers, in comparison with the native Dutch pregnancy outcomes.

 

Goedhart et al. 2008, Table 1.  Prevalence rates of total PTB, SPB and IPB per ethnic group
PTB: Preterm birth
SPB: spontaneous preterm birth
IPB: iatrogenic (medically indicated) preterm birth

 

Ethnicity Number of women Total PTB (n) Total PTB (%) SPB, n (% of PTB)* IPB Unknown subtype, n (% of PTB)*
Induction, n (% of PTB)* Primary section, n (% of PTB)*
Dutch 4099 209 5.1 159 (76.1) 10 (4.8) 26 (12.4) 14 (6.7)
Surinamese 608 56 9.2 35 (62.5) 7 (12.5) 6 (10.7) 8 (14.3)
Antillean 114 10 8.8 5 (50.0) 2 (20.0) 2 (20.0) 1 (10.0)
Turkish 380 19 5.0 14 (73.7) 2 (10.5) 0 (0) 3 (15.8)
Moroccan 661 27 4.1 11 (40.7) 0 (0) 4 (14.8) 12 (44.4)
Ghanaian 155 17 11.0 7 (41.2) 2 (11.8) 3 (17.7) 5 (29.4)
Other non-Dutch 1587 79 5.0 52 (65.8) 7 (8.9) 12 (15.2) 8 (10.1)
Total 7604 417 5.5 283 (67.9) 30 (7.2) 53 (12.7) 51 (12.2)

Asylum seekers are regarded as a vulnerable group by the UNHCR (UNHCR, 2014). The World Health Organisation (WHO) argued in early 2000 that there should be appropriate health care for all (Baum, 2007). One of the key elements was the achievement of equality in health status for vulnerable populations throughout the world (WHO, 1978). This statement means equality for people in terms of health status by means of providing the best health care available (Evans et al., 2001), as members of the international community the Dutch midwifery and obstetrical care society state their concerns regarding vulnerable pregnant women in the Netherlands (Altink et al., 2014; Midwifery in the Netherlands, 2014; NVOG, 2014). Their concerns focus on the pregnant asylum seekers because of the increased adverse pregnancy outcome regarding maternal and foetal morbidity and mortality (Goosen et al., 2010; Oostrum et al., 2011; Hanegem et al., 2011; Hayes et al., 2011). The healthcare issues surrounding the pregnant asylum seekers attracted the attention of politicians and as a result the government altered the policies and guidelines for the (pregnant) asylum seeker. The Directive 2003/9 / EC of the Council of 27 January 2003 which laid down minimum standards for the reception of asylum seekers, was improved with the mandatory reception regulations for a dignified standard of living conditions for (pregnant) asylum seekers (Eerste Kamer der Staten-Generaal, 2016).

The Central Agency for the Reception of Asylum Seekers, COA, is the organisation that provides hosting for the asylum seekers in the Netherlands (COA, 2014).

The COA outsourced the total asylum seekers’ health care requests to the Mensis-COA-Administrative MCA. The MCA is responsible for providing all layers of healthcare in terms of accessible, available and high-quality primary care for (pregnant) asylum seekers (MCA, 2014). This high-quality health care product is possible due to the governmental action articulated through the act regulating health care for asylum seekers Regeling Zorg Asielzoekers (RZA) (RZA, 2009). This RZA regulates all health care, which the asylum seekers are entitled to and enables them to meet their health care needs. The care for pregnant asylum seekers needs to consist of standard maternity midwifery care, and if appropriate, a referral to obstetrical care. High-risk pregnant asylum seekers’ health care needs to equal the obstetrical care provided to the native Dutch population.

In February 2014 the Health Care Inspectorate communicated that it was conducting a serial extensive nationwide multi-annual study of prenatal, natal and postnatal care in the Netherlands, with a particular focus on the vulnerable pregnant groups. The findings of the study indicate that the adverse pregnancy outcomes among pregnant asylum seekers were reduced (The Health Care Inspectorate, 2014).

This led to the statement of the Inspectorate that inter alia, referrals to hospitals and the use of professional interpreters would generate better maternity care for pregnant asylum seekers (The Health Care Inspectorate, 2014). According to the Inspectorate there are still health benefits to achieve in the health care of pregnant asylum seekers, despite the reduction in negative outcomes.

According to Rees (2011), in the midwifery care domain it is relevant and even necessary to work according to the principles of the Evidence Based Practice (EBP), paradigm, for example, it is essential to evaluate the practice (Lawless et al., 2014). However, there is little literature that describes and evaluates the care management through adjusted obstetrical policies and guidelines and how they are put into practice in the Netherlands with regard to pregnant asylum seekers. This study therefore aims to examine the views of midwives involved in the provision of maternity care for asylum seekers in relation to the current, recommended standards of care.

Literature review

Introduction

Maternal mortality and severe morbidity generally occur more frequently among migrants compared to host populations. In the Netherlands, political efforts have been made to reduce adverse pregnant asylum seekers outcome by adjust policies and guidelines. Therefore, reviewing national and international literature offers in-depth understanding of the topic.

Search strategy

A literature review was conducted from primary and secondary resources in order to understand the topic (Krainovich-Miller et al., 2009; McKibbon & Marks, 1998). Information was retrieved from a wide variety of sources, including journals, articles, books, grey literature, and encyclopaedias using predetermined keywords (derived from the research question) – midwives, asylum seekers, migrants, experience, opinion, policies and guidelines and synonyms (Craig & Smyth, 2012; Krainovich-Miller et al., 2009). Searches were carried out by using CINAHL and Medline (via EBSCOhost) and Pubmed from 2000-2016. The search engine supports gathering existing reliable information on a topic, which can be found in various resources in a structured manner. The findings of the search can be organised in a Prisma flow diagram (See Appendix 6). The researched literature was critically evaluated by use of the Critical Appraisal Skills Programme (CASP) to ascertain relevant insights about the study topic (CASP, 2013). By critically assessing the literature on the topic, this study aims to ascertain that the retrieved literature is significant and relevant. Furthermore, it was possible to establish whether there is a gap in the knowledge on the study topic within the literature. If the information was found to be appropriate, it was included as study data. Grey literature was processed with the same approach.

The Key Themes

As mentioned, reviewing national and international literature offers in-depth understanding of the topic. This is achieved by using key themes associated with adverse pregnancy outcome among asylum seekers.

A study by Correa-Velez and Ryan (2012) was included because it attempted to identify key elements that characterise the best practice model of maternity care for women who have an asylum-seeker background. It was identified that factors such as high-quality interpreter services, education strategies for healthcare qualified personnel and pregnant women, and the continuity of qualified health care providers were essential (Correa-Velez & Ryan, 2012). Several authors provided similar findings (Kurth et al., 2010; Merry et al., 2011; Hanegem et al., 2012), which suggest a certain consensus regarding key elements in asylum seekers’ health care. Correa-Velez & Ryan (2012) conducted a multifaceted project in Australia that included a literature review, consultations with key stakeholders, a chart audit of hospital use by African-born women in 2006 that included their obstetric outcomes, a survey of 23 African-born women who gave birth at a hospital in 2007–08, and a survey of 168 hospital staff members. This provided the study with an effective population frame to conduct a high-quality study (Gage & Norton, 2012). Yet, communication barrier is a key element that studies do not address; this difficulty affects patients as well as care providers. Furthermore, Rodrique et al. (2010) suggest that health activities should be guided by protocols.

According to Rodrique et al. (2010) activities are based on protocols, which is a complex issue. It is essential that health professionals are familiar with the recommended guidelines for good practice. Similarly, he argues that the awareness of the health professional on the protocols (adjust as needed) is the next step, which must be followed by reflection on the applied guidelines (Rodrique et al., 2010).

Moreover, Akavan (2012) highlights the importance of communication barriers as an obstacle to the provision of appropriate care.

The study outcome Akavan (2012) revealed that communication barriers were one of the main parameters, which led to unequal care between native Swedes and asylum seekers. This qualitative study was undertaken to understand the midwives’ views on inequalities due to immigrants’ status. Ten midwives of units in two municipalities with experience in providing care for asylum seekers were questioned in semi-structured interviews (Akavan, 2012). The study findings were transcribed and related categories were identified through content analysis.

The findings of these studies are further supported by a more recent qualitative study by Tobin and Murphy-Lawless (2014) who undertook an in-depth unstructured interview approach to explore the midwives’ experiences in providing care to asylum seekers. A purposive sample of ten midwives was drawn from two sites. Both sites are teaching hospitals with similar birth rates in excess of 9,000 per year. For a qualitative study, the sample of ten midwives appears acceptable, especially taken in to account the numbers of birth attended. The midwives were able to indicate based on their day-to-day experience which challenges they encounter while providing care to pregnant asylum seekers. Results were, for example, barriers to communication, understanding cultural differences, challenges caring for asylum seekers, emotional cost of caring and structural barriers to effective care (such as policies and protocols).

Knowledge gaps

Communication Barrier: Several Dutch studies indicated that the communication barrier due to poor language skills fostered adverse pregnancy outcomes. This especially seems to be the case for vulnerable pregnant women and their children, which includes pregnant asylum seekers. Alderliesten et al. (2007) in their study observed a delay by all ethnic groups, among them asylum seekers, in visiting an obstetrical health care professional for their first consultation. The study explained the findings by a high prevalence of the identified risk factor of poor Dutch language skills. The assumption is made by the study that poor skills in Dutch lead to disadvantages in acquiring essential information regarding different issues during pregnancy. The study by Hanegem et al. (2011) focused on the severe acute maternal morbidity (SAMM) risk factors for asylum seekers. The study included the entire population of pregnant asylum seekers from 98 maternity units in the Netherlands during a two-year timeframe, conducted through a prospective cohort perspective. The study revealed that one of the most important risk factors was the language barrier. Poor communication skills could influence the care process itself and the communication with the care provider. In addition to language and communication issues, problems associated with transfer of women with obstetric problems appeared to be an issue.

Transferral: Jong et al. (2014) conducted qualitative, semi-structured interviews with pregnant women to discover transfer challenges from a pregnant woman’s point of view. Participants came from different independent midwifery practices located in rural and urban areas. Participants reflected on the challenges they encountered during transfers. Study findings indicated that in some cases the participants experienced a feeling of fear. Others indicated that at times in the process of being transferred they felt confused and did not know what was happing. Overall the participants’ answers demonstrated that during the process of being transferred informational continuity and management continuity were highly valued. It was important for participants that professionals were aware of their medical situation and knew about their personal preferences. Participants indicated that they sometimes had the feeling that information got lost between providers from primary and secondary care during the transfer process. When study participants expressed their need for management continuity, they were referring to consistency and a coherent approach during the transfer from primary to secondary care. Women expressed that the midwife should accompany this transfer, and the midwife should stay until the woman has settled and trusted the secondary provider. The study does not distinguish between ethnicity of vulnerable groups, but only between the experiences of participants. This can be seen as a limitation, nevertheless it can be said that the study revealed (universal) findings that will be even more applicable to vulnerable groups, such as pregnant asylum seekers. Although this was a small qualitative study with limited generalizability, the larger quantitative study by Jans et al. (2015) supports the idea of women having a strong preference for continuity of care and carer. Jans et al.’s (2015) study population included 600 patient records from pregnant women who were referred during labour from primary to secondary care. The main reason for the transferral was the request for pain relief, which accounted for 31% of the total transfers, whereas 60% of the total transferrals required an intervention with additional pain relief. The study findings suggest that primary care midwives should be enabled to give continuity of care to a large group of women transferred from primary care to secondary care with a moderate risk profile. The study findings distinguish between moderate risk factors such as pain relief, meconium, prolonged first stage delivery, prolonged rupture of the membranes, prolonged second delivery stage and a high-risk profile (Jans et al., 2014). According to study findings in the Netherlands, all women who are transferred to obstetricians’ lead care are considered to have a high-risk profile. Conclusively the study points out that a moderate risk profile should be carried out by a midwife to maintain continuity of care during the transfer.

Care management: Alderliesten et al. (2007) comment that several strategies have been developed for the non-native Dutch speaking minorities. One of those alternatives is the implementation and routine use of interpreter services during consultation, in order to enhance the positive outcomes of pregnancies for these minorities. Akker et al. (2016) highlight that substandard care due to delays either by the patient or the health provider are frequent occurrences in the Netherlands. These findings were the result of a quantitative literature search, and showed that there is detailed evidence that emergency care delivered in refugee camps is of a higher standard than care delivered within the local health system. According to Akker et al. (2016) the reasons for this lie in the non-governmental organisations’ efforts to provide refugee camps with the best possible health care. A reference is made to the detailed evidence that pregnancy outcomes in refugee camps are often better than those of the local host population. The study findings reveal that a substantial part of the increased adverse health outcomes must be attributed to the suboptimal health care delivery in for instance the Netherlands. In the Netherlands suboptimal care was more frequently identified in cases of adverse maternal outcomes for non-natives when compared with Dutch natives. Some care is indicated while these study findings are dated 2016 based on empirical data from the first decade of 2000.

Conclusively, Akker et al. (2016) propose that non-native women require increased care during pregnancy and childbirth, which they are entitled to under the principle of universal access of care, to prevent adverse pregnancy outcomes.

Akker et al. (2016): Table 4.

SAMM and ethnic disparity: RR or OR of risk in migrants versus native-born women.

Country/year Maternities Number of SAMM/near-miss RR or OR
Netherlands, 2004–2006 [3] 358,874 2506 RR 1.3 (1.2–1.5)
United Kingdom 2005–2006 [64] 775,186 686 RR 1.58 (1.33–1.87)
Australia (Victoria) 2001–2010 [19] 636,042 1316 OR 2.0 (1.45–2.75)
Canada (Ontario) 2001–2010 [19] 1.050,688 3062 OR 1.5 (1.21–1.85)
Denmark 2001–2010 [19] 636,177 3085 OR 1.8 (1.4–2.21)
Sweden 1998–2007 [20] 914,474 2655 OR 2.3 (1.9–2.8)

Case manager: Perdok et al. (2016) studied the opinions of maternity care professionals and other stakeholders in the Netherlands by using a qualitative design, using the Consolidated Criteria for Reporting Qualitative Research checklist to study the data. The data revealed that most of the participants believed that client-centred care is a prerequisite for optimal care. In order to reach this goal, one of the issues is to link the collaboration between primary and secondary care to ensure the continuity of care. An alternative model of continuity of care could be a model where the midwife shifts from primary to secondary care in order to ensure the continuity of care. This can be visualised in cases of birth situations which start in primary care and transfer to secondary care while accompanied by the midwife who is the case manager. As this is the envisioned situation for the native pregnant population, asylum seekers should be treated in the same way (Perdok et al., 2016). However, study of the limited material shows that this vision is not widely spread or supported by policies and guidelines. The continuity of care methodology is supported by the majority of health providers and stakeholders; where the frequently mentioned model is that of the case manager (Erwich et al., 2015; Haaren-ten Haken et al., 2014; Hesselink & Harting, 2011). Erwich et al. (2015) used a qualitative study with purposive sampling to select potential practices. The study results, a total of 3,499 answers, were analysed using the software program Max Qualitative Data Analysis. The study findings recognised individualised care for pregnant women as a key element. Other findings from the study listed additional provider and service characteristics as further elements of advanced health care for mother and child. The provider characteristics were specified in elements such as interpersonal skills, i.e. the interactions with the client and others involved. Communication was another element that was specified as communication skills and information provision. The service characteristics were further divided into additional or adjusted care, assistance and support, time spent with client, continuity of care provider, continuity of care, and accessibility. The themes identified in the study are supported by national and international studies.

Factors associated with ethnicity: A nationwide confidential study into the causes of maternal mortality by Graaf et al. (2012) aimed to study regional differences in maternal mortality ratio (MMR) in the Netherlands. As the study unfolded they learned that non-Western pregnant women suffered an excess risk of MMR, which is the number of maternal deaths during a given period of time per 100,000 live births in the same period of time; this excess risk was also echoed by numerous European studies. Beside the lack of proper skills in Dutch, additional risk factors were found in inefficient pregnancy consultations, such as irregular consultation due to different causes.

Study justification

Since 2012 the Dutch authorities have focused on pregnancy healthcare for asylum seekers, with special emphasis on communication, referrals and documentation (The Health Care Inspectorate, 2014). The Health Care Inspectorate (2014) has announced that communication and referrals in health care need to be adjusted to provide responsible birth care for asylum seekers. In conclusion, the adjusted guidelines need another review and adjustment. Little information is available regarding the opinion of midwives working with the adjusted policy and guidelines while caring for pregnant asylum seekers. A search of the literature databases failed to find Dutch literature on the subject, and only a small number of studies that focused on asylum seekers. Moreover, no Dutch literature was found that studied the opinion of midwives working with the adjusted policy and guidelines while caring for pregnant asylum seekers. In the study by Akker et al. (2016) concerns were communicated regarding a possible reduction in access to interpreter services due to political anti-immigrant pressure, which could increase the communication barrier between non-natives (including asylum seekers) and health workers.

Short conclusion

The aim of this study is to explore the opinions of midwives in the Netherlands regarding the newly implemented policy and guidelines that are applicable to pregnant asylum seekers. In addition, it seeks to gain insight of midwives’ opinions regarding policy implementation to foster practice development.

Conclusion and recommendations

Conclusion

communication

Based on the analysed data it appears that the midwives who participated in the study respect the ruling policies and guidelines by practising them while providing health care to low-risk pregnant asylum seekers. These policies and guidelines are attached to the contract that independent midwifery practices have to sign if they want to provide health care to low-risk pregnant asylum seekers in the Netherlands.

The midwife respondents demonstrated a critical attitude through reflections on the adapted policies and guidelines while working with those that are used inter alia in independent midwife practices.

The issue that has been identified as strongly related to the less positive pregnancy outcomes among asylum seekers is the communication barrier, something that is frequently echoed in literature. The solutions regarding the communication barrier are diverse and are often reduced by using an interpreter to overcome problems. According to the policies and guidelines, midwifery practices are obliged to work with an interpreter for each consultation with a pregnant asylum seeker whenever there is a communication barrier. However, this is not done on a day-to-day basis. In this study 70 percent of the responders revealed that during the entire pregnancy there is a lack of interpreter services. In addition, that tells us that 30 percent of the respondents optimise the communication by using the interpreter service. The respondents from the midwifery organisations implied that relatively little use is made of the interpreter service in relation to the mandatory policies and high accessibility of the interpreter service. The underlining reasons for the experienced discrepancy are unclear and not revealed by the study data.

To summarise, study findings indicate that interpreter services are not being used to their full capacity, although the participating midwives agreed regarding the usefulness of decreasing communication barriers through an interpreter. Why the midwives use the interpreter services the way they do, is not answered or concluded in this study.

Transferral

The transferral (COA to the first line health provider (hp)); first line hp to the first line hp; first line hp to the second line hp) of prenatal, natal and postnatal care in cases of low-risk pregnant asylum seekers is viewed by the respondents as adequate and effective. The midwives indicated that the independent midwifery practices acted as the referring body in most of the cases. This is a consequence of the Dutch midwifery organisation, where midwives as primary care providers initially stand at the front of the health care system in the Netherlands. The Dutch midwiferies perform as gatekeepers of the transferral for low-risk pregnancy through the health care system in low-risk pregnancies.

The midwife can refer a low-risk pregnant woman to a second health care service if she decides that the woman no longer fulfils the criteria for a low-risk profile due to her care or health profile. This decision can be made during the first thorough consultation or later on in the care process.

The respondents’ opinion regarding the transferral through the health care system received an 80 to 90 percent score for correct standard care. Less than 20 percent of the respondents seem to consider the transferrals as inferior care. The study findings cannot define the reason for the 20 percent inferior transferral care.

To summarise: study findings indicate that midwife respondents consider low-risk asylum seekers’ pregnancy as correct transferral standard care. A small percentage of respondents, 20 percent, is of a different opinion. It was not in the study focus to reveal the underlying reasons.

Experience / management

Case management

The respondent midwives reviewed the quality of the Dutch obstetric care regulated by guidelines and policies for the low-risk population pregnant women as follows: The care is equal for pregnant asylum seekers and the Dutch native population according to 70 percent of the midwives.

In this interpretation a deviant of 30 percent believe that the quality of obstetric care for pregnant asylum seekers is not good enough based on the equivalence principle.

The quality of care management for low-risk pregnant asylum seekers is rated by 60 percent of the respondents to be equal to the care management for the Dutch native population. 40 percent of the midwives believe that while Dutch legal regulations are in place, care management on local level can be improved to optimise healthcare for low-risk pregnant asylum seekers. The issues or deficits that should be addressed to achieve a higher efficiency rate of care management for low-risk pregnant asylum seekers are not revealed through the study data.

To summarise: the findings of the study indicate that there are shortcomings observed by the responding midwives. These shortcomings are detected by the obstetrical care as well by the obstetrical management based on the principle of equality. Where those shortcomings are being observed, felt and reflected upon is not answered through this study.

Case manager

The responding midwives’ opinion of the use of a case manager to benefit pregnancy health care for asylum seekers scored 80 percent positive answers. The remaining 20 percent of the respondents did not support the majority’s opinion. The study’s focus was not to identify the reason for those 20 percent deviation and hence cannot identity the reason for it.

To summarise: the findings of the study indicate that the majority of the midwife respondents are very positive about using the concept of a case manager in the pregnancy care of asylum seekers. A small percentage of respondents, 20 percent, is of a different opinion. It was not in this studs focus to reveal the underlying reasons.

Factors associated with ethnicity

The concept of managing health care outcome by using a case manager during fixed consultations, and especially in particular obstetrical situations, is reflected upon with a score of 80 to 90 percent by the respondents. The dissent opinion of the remaining 20-10 percent is not disclosed within this study because of the focus of the study.

To summarise: The vast majority of respondents in the study indicated that the concept of a case manager on fixed consultation in health care situations by pregnant asylum seekers will have a positive influence on the obstetrical health outcome for mother and child. A minor percentage of respondents, 20- 10 percent, is of a different opinion. It was not in this study’s focus to reveal the underlying reasons.

Study limitations

Study results need to be interpreted in light of some limitations, whereas the main limitation lies in the nature of the sample. The recruitment of participating midwifery organisations was done by using the health care contracts from the insurance companies that are responsible for the health care accessibility of asylum seekers. The regulations require that a midwifery organisation can acquire a contract, as opposed to an individual practising midwife. As a consequence, the study population consists of independent midwifery practices. The owners of an independent midwifery practice do not have a mandatory requirement to communicate their legal entity to third parties. Additionally, they do not have to communicate how many co-workers they employ at any time. In conclusion, the recruitment of participating midwifery organisations was best answered by the concept of probability selection of participants, which included all independent midwifery practices able to deliver health care to asylum seekers in the Netherlands. Response rates cannot be calculated due to lack of precise information about the number of individuals in all independent midwifery practice organisations who received an invitation to participate.

The study findings were from a sample population, which is equal to the entire population. All independent midwifery practices with a healthcare contract for asylum seekers received the study questionnaire. The entire population contains 120 midwifery organisations with a return reaction of 34 (28%) responses, with 29 (24%) being fully completed. Because of the relatively low figures the study data were organised and combined to relevant parameter values. The results were presented in clear tables, graphs and figures, such as histograms, bar and line charts.

Inductive statistics through SPSS have not been used as the principle of predictions, estimations, testing hypotheses and deriving estimates about a population from data sampled from that population are not applicable to the study data. Despite the absolute small number of replies, but relatively large population, generalisations could be made because of the nature of the study population.

Implications and recommendations

There are currently limited data on the perspectives of midwives who provide care to childbearing women while they are in the process of seeking asylum. The aim of the study was to review the extent of implementation adjusted policies and guidelines as these guidelines are in the process of being tightened again. Study findings revealed that the participating midwives for the vast majority seemed to work correctly and timely according to the policies and guidelines. The results from the study suggest the need to investigate an in-depth opinion perspective by performing a qualitative study to discover the relatively low percentage of deviating findings.

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