Dutch midwifery

Dutch midwifery an inspiration to the global community

Dutch midwifery an inspiration to the global community Voorwoord

Compilation Layout Press Photos www.midwives4mothers.nl

Franka CadÊe Annemiek Voogd Ovimex bv, Deventer Josef Rabara Š July 2014

“

Significant new evidence from the Lancet series on Midwifery [June ’14] shows that a global shift in maternity services is necessary to provide safe and appropriate care for women and their families during pregnancy, childbirth and the postnatal period. The key to this shift lies in the hands of the midwife who, together with the women and her family, can safeguard continuity of care, maintain normality and intervene or refer where medically appropriately within a congruent maternity team.

The Dutch maternity system is also undergoing change. Within the current system, there are elements that are viewed with awe and admiration by the global midwifery community. This includes the real choice of place of birth - varying from home to birthing centre or hospital, emergency obstetric services close at hand, physiologically minded midwives and obstetricians and autonomous primary care and hospital based midwives.

The correct use of these elements can be crucial to drive the change in the Netherlands in the right direction. Internationally eyes are upon the Dutch midwifery system, a model perceived as a beacon of quality valued care. Each year midwives and policy makers from around the globe visit the Netherlands to be inspired by it.

The global midwifery community views and perspectives of the Dutch maternity system are captured in this book. They exemplify a system that the Dutch may be proud of.”

Frances Day-Stirk – midwife, President International Confederation of Midwives (ICM)

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Choice of childbirth by the woman should be respected.

As maternity care providers we should provide support and advice based on available local evidence to improve safety and quality. The risks are better expressed as absolute and not as relative as that ‘magnifies’ the perception. One to one midwifery care is essential whether it is a well or less resourced country or whether it is a low or high risk mother.

Compassionate care by a continued companion such as a midwife reduces interventions, increases breast feeding and enhances bonding. Hence we need to work together to increase well trained midwives throughout the world and make sure they are provided with safety at place of work and the resources for continued in-house education and training.

With home births or births in stand-alone midwifery units there should be local multidisciplinary arrangements which reassures women.”

Sir Sabaratnam Arulkumaran – Obstetrician, Professor Emeritus , UK St George’s University of London

bonding

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Dutch midwifery has a primary care model recognising the autonomy of midwives. Access to home birth for low risk women. Dutch midwifery is an important example of well-trained skilled midwives for the global community.”

Professor Lesley Page – Midwife, President Royal College of Midwives UK

important

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In the Netherlands there is autonomous midwifery with high quality standards. Midwives are valued in primary care & there are safe and free choices for mothers.”

Tekst Susanne Simon – Midwifery educator/PHD student Germany

quality

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I am hopeful that as autonomous midwifery practice has been the norm since 1990 in New Zealand that we too will develop a heritage such as the one in the Netherlands of strong and confident child bearing women.”

Sue Lennox – Midwife, PhD, President, New Zealand College of Midwives New Zealand

strong

“

Dutch midwifery care is the primary healthcare for childbearing women. The fact that the government reimburses midwifery services for all women is indicative of the value the Dutch system places on women’s health. The autonomy of the Dutch midwives to practice without physician supervision is far superior to anything that we have in the US. Given the health indications are so much better in the Netherlands than the US, shows me that their system, that incorporates midwives, is far superior to what we have in the US.” Diane Holzer – Midwife, LM, CPM, PA-C Immediate Past President of Midwives USA Alliance for North America

superior

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I admire that home birth is integrated in Dutch society.

It is considered normal and safe. In Germany home births are very rare and midwives might not be able to continue attending home birth services because of the bad insurance situation. I would like to transfer the Dutch natural conception of pregnancy and birth.”

Lea Wendt – Student Midwife, Hochschule fur Gesundheit Bochim Germany

natural

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Dutch midwifery system is strong, it presents as a best practice model & offers choices to women.

I personally think that world midwives look upon Dutch midwifery system with pride and quote its example.

Please sustain it, to keep it for the sake of women!”

Dr Rafat Jan – Midwife, Director (Midwifery) Associate Professor, School of Pakistan Nursing & Midwifery, Pakistan

sustain

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The option to choose a midwife for antenatal care, birth at home and postnatal care are the norm in the Netherlands.

Not to be thought of as ‘a patient’ but as a woman performing a normal function. Being a part of a social system rather than a part of a medical system. Do not loose something so valuable.”

Mary Higgins – Midwife, International Officer, Ireland midwives Section Irish Nurses & Midwives Organisation

option

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As a young American I heard stories of the autonomous independent Dutch midwife riding her bicycle to home visits. This is how I wanted to practice; independent, setting my own schedule and forming a relationship with the women cared for. I still strive to reach this goal.

This valued aspect is the same one I would like to transfer to my country.”

Colleen Donovan-Batson – Midwife CNM, MS Midwives Alliance op North USA America

relationship

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Dutch midwifery is women centered, it’s a continuity of care system for women, it’s a very inspirational system. It’s system that is very safe for women.”

Marketa Zemanova – Midwife Czech Republic

safe

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I would like to transfer the Dutch Caesarean section rate of 15% to the UK – which has a Caesarean section rate really of 30%. I would also like to transfer the student experience. I have just spoken to a Dutch student midwife who is at the end of her 2nd year. She has been to ELEVEN home births- most UK students don’t see any home births in three years of training. I would also preserve and transfer the belief in physiological birth.”

Mary Stewart PhD – Midwife researcher, University College London UK

home births

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In the Dutch Midwifery System, a pregnant woman who has no complications can receive prenatal-, birth-, and postnatal care as a continuum of care in one group practice of midwives. The pregnant woman gets to know all midwives in the practice during pregnancy and by the time she comes to delivery all midwives are known to her. There is a comprehensive list of indications that require consultation with an obstetrician/gynaecologist, without necessarily a transfer of the woman to hospital care.

A 24/7 emergency obstetric service is available to both patient and midwife in case of an emergency developing at home.

The beauty of the system is also that every woman has access to a maternity nurse who will be called during labour, who assists the midwife during the home delivery and who stays for several days after delivery (usually four to seven days, depending on the insurance) to take care of mother and baby and to help in the household.�

Barbara E. Kwast – Midwife, PhD International Consultant The Netherlands

acces

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I value the Dutch maternity assistant for her preventative role and support of the midwife. Home births in relatively small practises of three midwives. The social and cultural aspects of prenatal care.”

Professor Edwin van Teijlingen – Professor of Reproductive Health UK Research, Bournemouth University

support

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The Dutch midwifery care system has good outcomes with a high client satisfaction. Adding to this it is cost effective.

I hope we can export this model.”

Marian van Huis – Midwife, ICM treasurer 2008-2014 The Netherlands

cost effective

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The Dutch midwives need to maintain their autonomy and independence. The Dutch women must be given the chance to choose who they want to be with throughout pregnancy. Of course the midwife is the best choice for the woman. The midwife has the time and the understanding.”

Theresa Antiwi – Midwifery Tutor Ghana

understanding

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Dutch mothers can give birth at home, if they want to.

The society has organized support for home care. A midwife makes visits at home. During those visits she can see the condition of the mother and the new-born baby during several days.”

Raija Rapo – Head midwife Finland

organized

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The Dutch Midwifery Association is a formidable body to reckon with. The most valuable aspect of their practice is the level of autonomy midwives have in that part of the world.

Therefore it must be maintained and improved upon where necessary.”

Safiatu Agnes Foday – Midwife, MSc, President Sierra Leone Midwives Association Sierra Leone

autonomy

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The Dutch have excellent access for all women to an educated and regulated midwife. Access to home birth where appropriate. Clear pathways of care for women requiring different care providers such as in de case of medical complications. Strong and critical focus on postnatal care and transition to parenting. Regulation of the profession is very strong. Educational standard of the profession is excellent! Status of the Profession; well known! Partnership with users of the service -Women and families. Safety and quality matched by choice, access to appropriate birth place including families homes.”

“

Home birth is a good system where the woman and midwife can co-operate and work together for safe birth. The continuity of care in the Dutch midwifery system is scientific and safe for the woman and her family. In Norway we would like to have this model and we are moving slowly towards something similar. The Dutch midwifery system is good, safe and costeffective.”

Synne Holan – Lecturer, researcher Vestfold University College, Norway Department of Health Promotion

Rachael Lockey – Midwife, Director of midwifery, Cape York Australia

partnership

scientific

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In France we admire and envy the Dutch system for the - recognized - place of the midwife as ‘first line’ for perinatal care. For her skills in physiology, and the choices the system offers to pregnant women.”

Henny Jonkers – Sage - femme France

admire

“

As an independent birth-centre and home birth midwife I value most the autonomy of the Dutch midwives, which is unrivalled.

Furthermore, the supportive environment of the system and the true collaborative, team approach are invaluable.”

Debrah Lewis – Midwife Trinidad & Tobago

value

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I would like to have the same system of a professional midwife to help women in continuity of care , regarding the home as the first choice of place of birth for every healthy woman expecting a healthy baby. Holland is seen by us in Denmark as a country with a very high standard of healthy choice for women and their babies and families. You respect women and at the same time you use your high level of midwife competencies.”

Kit Dynnes Hansen – Midwife, Vice President, Danish Association of Midwives: Denmark RM, MPH, Supervising midwife

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I find this very important that you have a model of midwifery care that offers continuity of care. That Holland stands as a beacon to those interested in opposing unnecessary interventions. And a model that recognizes birth as a physiological process that can happen in safe surroundings in a home, given that a well-trained competent midwife is present, a midwife with the skills to discern and refer and follow. I would love to have the common knowledge in Denmark that midwifery care is safe- where ever de woman gives birth!”

Lillian Bondo – Midwife, MPA, President The Danish Association of Midwives Denmark

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In Holland the mother can choose her place of birth.

Good midwifery education.”

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In the Netherlands I value that midwives are lead clinicians for well women. That they have status in the medical system and in the community with excellent birth outcomes.

Publicity funded care. Obstetricians & hospital when needed but not routine.”

Lucie Kasova – Midwife Czech Republic Maxine Hardinge – Midwifery Lecher (Bachelor Midwifery) Australia

education

status

“

Holland has a free choice of birth place. At home with a well-educated midwife, knowing the woman already during the pregnancy. I would also like the midwife next to me during the whole labour.

Observing my labour and giving me the support that ‘I can do this’. She is strengthening me in this magical moment.

In my life, my family and my newborn.”

Serena Debonnet – Midwife, Vice president Belgium Midwives Association, Belgium Lactation consult IBCLC

support

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When giving birth in the Netherlands women have the crucial opportunity to be accompanied by human, independent and accessible midwives. In fact, the Dutch midwives are at the core of the process of childbirth in its human dimensions: medical, social and psychological.

I consider the Dutch midwifery model an international reference for two major reasons: - Midwives are used to practice a home birth as it is considered a natural act in which the mother feels more relaxed in a familiar environment, surrounded by her family, which makes her pain of childbirth more bearable.

- They are qualified to supply clinical quality care in a humanistic approach and ideally give the ‘care’ to the mother and child before, during and after birth.”

Hanane Masbah – Midwife & policy advisor Ministry of health Morocco

crucial

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The basic education in the Netherlands on physiological birth resulting in value system promoting physiology and non-interventionist birth.”

Kathy Herschderfer – Midwife, PhD, consultant, former CEO ICM, The Netherlands Independent International midwife consultant

basic

“ “

In the Netherlands there is real real autonomy of midwives, working from a community base in group practices.”

Elizabeth Duff – Senior Policy advisor National Childbirth trust (NCT) UK

The Dutch midwifery system was always my favorite caring system. I looked for midwifery care in Germany when I was pregnant with my first child, I couldn’t find support for my wish to give birth at home. I was only 20 Kilometers distance away from the Dutch border. I had to go to hospital and didn’t know who would be caring for me. Now I am a midwife myself, I know how important it is to give a woman a safe feeling, to be with the woman during birth and care for her after birth.

Keep on caring for the normal birth, keep your system mother and baby friendly.”

Veronika Bujny – Midwife Germany

community

care

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The Dutch midwifery system has been held up as an ideal for many years, a system to be proud of, where midwives and mothers work together to keep birth normal. The home birth ratio is envied by many and used as an example of good quality midwifery care.”

Carmel Bagness – Midwife, midwifery & women’s health adviser, UK Nursing Department, Royal College of Nursing

proud

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Twenty five years ago New Zeeland based its redesign of its maternity service on the Dutch midwifery system.

Dutch midwifery provided then and now, a role model for other countries to aspire to. They can demonstrate the advantages to women and babies in having a known midwife based in the community providing autonomous competent woman centered care. Dutch midwives also demonstrate the advantages to the whole maternity workforce in having a strong knowledgeable midwifery workforce to rely on.”

Karen Gilliland – Midwife, Chief Executive Officer of the New Zeeland New Zealand College of midwives

competent

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I Value Dutch midwives, first because of their history and legacy of promoting and protecting normal physiologic childbirth in a world where it is disappearing.

Second, because of the autonomy they have achieved in the maternity care system, they encourage women to be self-determined in making well-informed choices about their own care and that of their infants and families.

And lastly I value the Dutch midwives for achieving excellent outcomes for mothers and their infants – some of the best in the world! BRAVO DUTCH MIDWIVES.”

Geraldine Simkins – CNM, MSN, Midwife, Executive Director USA

choices

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I work in large, collaborative Practice in Boston. Women have the choice of delivery with a midwife or GynOb. 60-70% choose a midwife and most of our physicians believe we provide better care to women. I have met maternal- fetal specialist obstetricians who prefer to collaborate with midwives over generalist obstetricians.

I sincerely believe midwives should be the first contact a pregnant woman has, midwives are uniquely trained to optimise and nurture normal and to screen for abnormal circumstances and appropriately refer. The Dutch model should be preserved, do not revert to a maternity model typical of those found in the US!”

“

The long history of autonomous practice historically in good collaboration with obstetric and other colleagues and with confidence in the benefit of normal physiological birth at home. Dutch midwifery has been a beacon for the world in that respect. To lose any of the aspects I have noted will be a tragedy for Dutch women, for midwives and their obstetric colleagues and for the world.”

Professor Soo Downe – Midwife, Professor of Midwifery Studies, UK University of Central Lancashire

Naomi Feingold CNM – Certified nurse-midwife USA

nature

confidence

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The concept of ‘Independent Midwives’ in Holland is very good. The midwives are truly empowered.

Please keep your system!”

Dr Address Malatta – Midwife PhD, MScN, principal of the Kamuzu College of Malawi Nursing at the University of Malawi, Vice president ICM

empowered

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The world is watching the unique Dutch maternity care system. They deliver the standard that other countries should seek to facilitate. Women have true choices and receive the support they need to have an empowering experience. The Dutch midwifery system is the inspiration for midwifery globally.”

Anna van Hörsten – Midwife (independent) UK

unique

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A high homebirth rate which ensures that midwives keep up their skills in supporting normal birth and reduce unnecessary intervention and morbidity in mothers and babies.

Confident midwives confident mothers and healthy babies.

The world is looking at the Dutch system which was highlighted in the Human rights and Child Birth Conference in The Hague.”

Elke Heckel – Midwife (independent) UK

supporting

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Midwives are the frontline workers in midwifery care as they are professionally trained to offer quality services to women, children and families in their reproductive years. Dutch midwives offer emotional support to women in a special environment that cannot be replaced by any other professional. They are special.”

Dr Joan H. Shepard – Midwife, PhD. Principal Midwifery school, Freetown Sierra Leone

special

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Many Dutch midwives practice independently. Home deliveries are still quite popular in the Netherlands. This is a great tribute to Dutch midwives competence and a model for other countries.”

Dr Rita borg Xuereb – Senior Midwifery lecture, Head, department of Midwifery, Malta Faculty of Health Sciences, University of Malta

popular

“

Dutch midwifery means community care. Home birth.

Normality versus pathology.

Clarity of reasons for transfer. Autonomous profession.

Great data collection systems.

Strong emphasis and understanding about physiology versus pathology. Strong focus on homebirth being usual for healthy women. Community midwifery. Working closely with maternity care assistants.”

Professor Caroline Homer – Midwife, PhD. Professor of Midwifery, Australia faculty of Health, University of Technology, Sydney

focus

“

Maternity care in the Netherlands has long been a model for other countries who wish to reduce unnecessary, costly, and harmful interventions in birth. While other countries struggle to reduce cesarean section rates that hover in the mid-30% range, the Dutch continue to have the lowest rate in the developed world, around 16%. While other countries struggle to give women choice of where they will have their babies, in the Netherlands, more than 30%of women have their babies primary care settings – at home or in the polyclinic – where they are not subject to medical routines that disturb birth.

While other countries would like to lower the rates of epidural anesthesia and induced labors, here too the Dutch lead the way with the lowest rates among first world countries.

And this sensible approach to birth is associated with respectable outcomes. I know there has been concern about the outcomes of the Dutch system, the data show that the Netherlands has better outcomes than several countries that insist that all births happen under the watchful and nervous eye of the obstetrical specialist, including Poland, Ireland, Austria, France, the United Kingdom and Denmark.

In short, the Dutch obstetric system is still vastly better at supporting normal, physiologic birth than those in all other developed countries.”

Professor Raymond de Vries – University of Michigan Medical School USA

“

I, along with other midwives in the UK, have always valued and indeed respected the Dutch midwifery system. All women in Holland have had equity of access to midwives and those midwives have been autonomous, decision makers who have stood up to the position that birth is usually a normal physiological process and in their practice have enhanced this possibility for women. Dutch midwives have however every importantly been skilled at identifying those women who need more support and different expertise if a woman’s birth experience is to be positive with a safe outcome for the woman and her baby. The Dutch midwifery system has everyone always acknowledged the importance of the multidisciplinary team, mutual professional respect and good communication.

Finally it is hugely significant to UK midwives that women in Holland have been able to choose their ideal place of birth including home. The importance of choice of place of birth in ensuring positive outcomes for low risk women is not underpinned in the UK by high quality research.

Dutch midwifery has been ahead of the game.”

Professor Cathy Warwick CBE – Midwife, Chief Executive Royal College of midwives UK

skilled

The International Confederation of Midwives (ICM) is the world’s largest organisation of midwives associations. With member associations in over 100 countries, ICM is the voice of more than 300,000 professional midwives around the globe.

ICM works primarily through these member associations toward the attainment of improved health outcomes for women and their newborn infants. ICM strengthens associations by ensuring that they have the tools needed to contribute to policies affecting maternal-newborn health; advance midwifery education and regulation; and offer quality midwifery care.

Together with its members, ICM works in partnership with many other stakeholders to achieve common goals in the care of mothers and newborns.

These include the World Health Organization and other UN Agencies; global professional health care associations such as the International Federation of Gynaecology and Obstetrics (FIGO), the International Pediatric Association (IPA) and the International Council of Nurses (ICN); non-governmental organisations; and civil society groups.

White Ribbon NL is a grassroots movement advocating the reduction of maternal mortality. Pregnancy and childbirth are the biggest killers of young women in many countries; 800 women still die every day.

Most of these deaths are preventable.

White Ribbon NL believes that every woman, no matter where she lives, has the right to a safe and respectful pregnancy and birth. Therefore we are uniting and informing citizens, professionals, press and politics to inspire them to take action to save the lives of women and newborns around the world.

Save lives, empower midwives!

The European Midwives Association (EMA) is a non-proďŹ t and non-governmental organisation of midwives, representing midwifery organisations and associations from the member states of the European Union (EU) and the European Economic Area (EEA) and EU applicant countries. The midwifery community across EU is united in sharing best practices as well as pro-actively inuencing development of national maternity services. EMA gives advice regarding EU policies and Directives to ensure quality and safety of health service systems to beneďŹ t the health of EU citizens. We acknowledge that member states like the Netherlands where midwives truly work with women, support women’s choice as well as provide woman-centred continuity of care are the exemplary template of midwifery profession.

The independent charity midwives4mothers (m4m) was established in 2010 by the Royal Dutch Organization of Midwives (KNOV) and is for, by and with midwives. The lives of mothers and babies would be healthier and even saved if every woman had access to a midwife [1] [2]. Midwives4mothers is committed to empower midwives globally to stand united in order to deliver this care to women and their families during pregnancy and childbirth as well as the postnatal period.

We do this by: s 3UPPORTING AND EMPOWERING QUALIlED MIDWIVES s %STABLISHING AND SUPPORTING A PROFESSIONAL EXCHANGE BETWEEN ASSOCIATION of midwives s 3TIMULATING CO DEVELOPMENT BETWEEN INDIVIDUAL MIDWIVES TWIN TWIN s 3UPPORTING MIDWIVES BY REFRESHER TRAINING s -ONITORING THE QUALITY OF CARE

BY STIMULATING MIDWIFERY REGISTRATION www.midwives4mothers.nl info@midwives4mothers.nl [1] Lancet Series: Midwifery ’14 [2] UNFPA, State of the World midwifery report ’14