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Introduction: We know a great deal about how childbirth is affected by setting; we know less about how the experience of birth is shaped by the attitudes women bring with them to the birthing room. In order to better understand how women frame childbirth, we examined the relationship between birth place preference and expectations and experiences regarding duration of labor and labor pain in healthy nulliparous women.Methods: A prospective cohort study (2007-2011) of 454 women who preferred a home birth (n = 179), a midwife-led hospital birth (n = 133) or an obstetrician-led hospital birth (n = 142) in the Netherlands. Data were collected using three questionnaires (before 20 weeks gestation, 32 weeks gestation and 6 weeks postpartum) and medical records. Analyses were performed according to the initial preferred place of birth.Results: Women who preferred a home birth were significantly less likely to be worried about the duration of labor (OR 0.5, 95%CI 0.2-0.9) and were less likely to expect difficulties with coping with pain (OR 0.4, 95%CI 0.2-0.8) compared with women who preferred an obstetrician-led birth. We found no significant differences in postpartum accounts of duration of labor. When compared to women who preferred an obstetrician-led birth, women who preferred a home birth were significantly less likely to experience labor pain as unpleasant (OR 0.3, 95%CI 0.1-0.7). Women who preferred a midwife-led birth - either home or hospital - were more likely to report that it was not possible to make their own choices regarding pain relief compared to women who preferred obstetrician-led care (OR 4.3, 95%CI 1.9-9.8 resp. 3.4, 95%CI 1.5-7.7). Compared to women who preferred a midwife-led hospital birth, women who preferred a home birth had an increased likelihood of being dissatisfied about the management of pain relief (OR 2.5, 95%CI 1.1-6.0).Discussion: Our findings suggest a more natural orientation toward birth with the acceptance of labor pain as part of giving birth in women with a preference for a home birth. Knowledge about women's expectations and experiences will help caregivers to prepare women for childbirth and will equip them to advise women on birth settings that fit their cognitive frame. [ABSTRACT FROM AUTHOR]

Background As part of the move toward 'patient-centered care,' women's preferences with regard to maternity services have become increasingly important to policy makers. To realize optimal patient-centered care, knowledge of patients' preferences is essential. The aim of our study was to assess the strength and relative importance of women's preferences for different aspects of intrapartum care in The Netherlands, where women have easy access to both home and hospital birth. Methods A discrete choice experiment was conducted at 16 weeks of gestation as part of a Dutch multicenter, prospective cohort study from 2007 to 2011 of low-risk, nulliparous women. Responses were analyzed per intended place of birth group: midwifery-led home ( n = 191) and hospital birth ( n = 152) and obstetric-led hospital birth ( n = 188). Results We analyzed 562 questionnaires. Women in all groups preferred the possibility of influencing decision making and pain-relief treatment during birth and no co-payment for childbirth. Women with an intended home birth preferred a home-like birth setting with the assistance of a midwife and transport during birth in case of complications. Type of birth setting and transport during birth were not considered important to women with an intended midwifery- or obstetric-led hospital birth. Conclusion Policies aimed at the improvement of maternity care must take into account women's preferences for the possibility of pain-relief treatment and the fact that all women desire a high level of involvement in decision making. Furthermore, efforts to change maternity care systems must consider how to counter the culturally embedded nature of women's preferences. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion To construct birthweight charts customised for maternal height and evaluate the effect of customization on SGA and LGA classification.Data were extracted (n = 21 350) from the MiCaS project in the Netherlands (2012–2020). We constructed the MiCaS‐birthweight chart customised for maternal height using Hadlock's method. We defined seven 5‐centimetre height categories from 153 to 157 cm until 183–187 cm and calculated SGA and LGA prevalences for each category, using MiCaS and current Dutch birthweight charts.The MiCaS‐chart showed substantially higher birthweight values between identical percentiles with increasing maternal height. In the Dutch birthweight chart, not customised for maternal height, the prevalence of SGA (p90) increased with increasing height category, from 1.4% in the lowest height category to 21.8% in the highest category (range 20.4%). In the MiCaS‐birthweight chart, SGA and LGA prevalences were more constant across maternal heights, similar to overall prevalences (SGA range 3.3% and LGA range 1.7%).Compared to the current Dutch birthweight chart, the MiCaS‐birthweight chart customised for maternal height shows a more even distribution of SGA and LGA prevalences across maternal heights. [ABSTRACT FROM AUTHOR]

In the Netherlands adverse perinatal outcomes are also associated with non-medical factors which vary across geographical locations. This study analyses the presence of non-medical vulnerabilities in pregnant women in two regions with high numbers of psychosocial adversity using the same definition for vulnerability in both regions. A register study was performed in 2 regions. Files from women in midwife-led care were analyzed using a standardized case report form addressing non-medical vulnerability based on the Rotterdam definition for vulnerability: measurement A in Groningen (n = 500), measurement B in South-Limburg (n = 538). Only in South-Limburg a second measurement was done after implementing an identification tool for vulnerability (C (n = 375)). In both regions about 10% of pregnant women had one or more urgent vulnerabilities and almost all of these women had an accumulation of several urgent and non-urgent vulnerabilities. Another 10% of women had an accumulation of three or more non-urgent vulnerabilities. This study showed that by using the Rotterdam definition of vulnerability in both regions about 20% of pregnant women seem to live in such a vulnerable situation that they may need psychosocial support. The definition seems a good tool to determine vulnerability. However, without considering protective factors it is difficult to establish precisely women's vulnerability. Research should reveal whether relevant women receive support and whether this approach contributes to better perinatal and child outcomes.

Objectives: To validate the Birth Beliefs Scale (BBS) for maternity care professionals by testing: (1) content validity; (2) internal reliability; (3) known-group discriminant validity; and examine potential relationships between regions and birth beliefs., Methods: First, content validity was tested. Before distribution of the questionnaire among maternity care professionals of six maternity care networks (MCNs), adjustments in the statements were made whenever content validity was too low. Data were collected from November 2022 to March 2023. Statistical analysis was performed using Cronbach's alpha, ANOVA and regression analysis., Results: Based on the content validity-test, item 6 of the questionnaire was adjusted before distribution. In total, 199 maternity care professionals completed the questionnaire. A good internal reliability of the BBS was found. There was a significant difference between the different disciplines for the BBS-Med subscale ( p  < .001), and the BBS-Nat subscale ( p  < .001). For the BBS-Nat subscale, the factors work experience and MCN were significant in the regression analysis, with interaction on the association between BBS-Nat and discipline., Conclusions: The BBS is a valid instrument to measure birth beliefs among maternity care professionals. The BBS can help to create awareness within professionals of their beliefs and may help to explain practice variation in childbirth.

Background: A positive childbirth experience is an important outcome of maternity care. A significant component of a positive birth experience is the ability to exercise autonomy in decision-making. In this study, we explore women's reports of their autonomy during conversations about their care with maternity care practitioners during pregnancy and childbirth., Method: Data were obtained from a cross-sectional survey of women living in The Netherlands that asked about their experiences during pregnancy and childbirth, including their role in conversations concerning decisions about their care., Results: A total of 3494 women were included in this study. Most women scored high on autonomy in decision-making conversations. During the latter stage of pregnancy (32+ weeks) and in childbirth, women reported significantly lower levels of autonomy in their care conversations with obstetricians as compared with midwives. Linear regression analyses showed that women's perception of personal treatment increased women's reported autonomy in their conversations with both midwives and obstetricians. Almost half (49.1%) of the women who had at least one intervention during birth reported pressure to accept or submit to that intervention. This was indicated by 48.3% of women with induced labor, 47.3% who had an instrumental vaginal birth, 45.2% whose labor was augmented, and 41.9% of women who had a cesarean birth., Conclusions: In general, women's sense of autonomy in decision-making conversations during prenatal care and birth is high, but there is room for improvement, and this appeared most notably in conversations with obstetricians. Women's sense of autonomy can be enhanced with personal treatment, including shared decision-making and the avoidance of pressuring women to accept interventions., (© 2022 The Authors. Birth published by Wiley Periodicals LLC.)

Introduction: Midwifery education that strengthens self-efficacy can support student midwives in their role as advocates for a physiological approach to childbirth., Methods: To assess the effect of an educational intervention on self-efficacy, a pre- and post-intervention survey was administered to a control group and an intervention group of third year student midwives. The General Self-Efficacy Scale (GSES) was supplemented with midwifery-related self-efficacy questions related to behaviour in home and hospital settings, the communication of evidence, and ability to challenge practice., Results: Student midwives exposed to midwifery education designed to strengthen self-efficacy demonstrated significantly higher levels of general self-efficacy (p = .001) when contrasted to a control cohort. These students also showed significantly higher levels of self-efficacy in advocating for physiological childbirth (p = .029). There was a non-significant increase in self-efficacy in the hospital setting in the intervention group, a finding that suggests that education may ameliorate the effect of hospital settings on midwifery practice., Discussion: In spite of the small size of the study population, education that focuses on strengthening student midwife self-efficacy shows promise., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: The aim of this paper is to identify and explain the factors that make up a woman's experience of the perinatal period. We accomplish this by validating a framework, described in an earlier study, that identifies the distinct dimensions of the perinatal experience., Design: We conducted a scoping review, using five online databases, to identify and categorize studies that investigate women's experience of the perinatal period., Findings: We found 251 publications that focused on the experience of the perinatal period. Our review confirmed the seven dimensions of our framework describing women's experiences of the perinatal period - the woman as unique individual, the woman as active participant in care, the responsiveness of maternity care and health services, the lived experience of being pregnant, giving birth and the postpartum period, communication and relationships with care providers, information and childbirth education, and support from social environment. One new dimension emerged from the studies we identified: societal influence. The resulting eight dimensions provide a comprehensive overview of the important aspects of women's experience of the perinatal period. While each dimension is distinct, there are significant overlaps and close relationships between them., Conclusion: The framework is a useful guide for healthcare providers, researchers, and policy makers who wish to improve the experience of the perinatal period. It is important to remember, however, that the current framework is dynamic, open to new insights and further development and refinement., Competing Interests: Declaration of Competing Interest None Declared., (Copyright © 2020. Published by Elsevier Ltd.)

Background: In 2009, the Steering Committee for Pregnancy and Childbirth in the Netherlands recommended the implementation of continuous care during labor in order to improve perinatal outcomes. However, in current care, routine maternity caregivers are unable to provide this type of care, resulting in an implementation rate of less than 30%. Maternity care assistants (MCAs), who already play a nursing role in low risk births in the second stage of labor and in homecare during the postnatal period, might be able to fill this gap. In this study, we aim to explore the (cost) effectiveness of adding MCAs to routine first- and second-line maternity care, with the idea that these MCAs would offer continuous care to women during labor., Methods: A randomized controlled trial (RCT) will be performed comparing continuous care (CC) with care-as-usual (CAU). All women intending to have a vaginal birth, who have an understanding of the Dutch language and are > 18 years of age, will be eligible for inclusion. The intervention consists of the provision of continuous care by a trained MCA from the moment the supervising maternity caregiver establishes that labor has started. The primary outcome will be use of epidural analgesia (EA). Our secondary outcomes will be referrals from primary care to secondary care, caesarean delivery, instrumental delivery, adverse outcomes associated with epidural (fever, augmentation of labor, prolonged labor, postpartum hemorrhage, duration of postpartum stay in hospital for mother and/or newborn), women's satisfaction with the birth experience, cost-effectiveness, and a budget impact analysis. Cost effectiveness will be calculated by QALY per prevented EA based on the utility index from the EQ-5D and the usage of healthcare services. A standardized sensitivity analysis will be carried out to quantify the outcome in addition to a budget impact analysis. In order to show a reduction from 25 to 17% in the primary outcome (alpha 0.05 and bèta 0.20), taking into account an extra 10% sample size for multi-level analysis and an attrition rate of 10%, 2 × 496 women will be needed (n = 992)., Discussion: We expect that adding MCAs to the routine maternity care team will result in a decrease in the use of epidural analgesia and subsequent costs without a reduction in patient satisfaction. It will therefore be a cost-effective intervention., Trial Registration: Trial Registration: Netherlands Trial Register, NL8065 . Registered 3 October 2019 - Retrospectively registered.

Background: The maternity care system in the Netherlands is well known for its support of community-based midwifery. However, regular midwifery practices typically do not offer caseload midwifery care - one-to-one continuity of care throughout pregnancy and birth. Because we know very little about the outcomes for women receiving caseload care in the Netherlands, we compared caseload care with regular midwife-led care, looking at maternal and perinatal outcomes, including antenatal and intrapartum referrals to secondary (i.e., obstetrician-led) care., Methods: We selected 657 women in caseload care and 1954 matched controls (women in regular midwife-led care) from all women registered in the Dutch Perinatal Registry (Perined) who gave birth in 2015. To be eligible for selection the women had to be in midwife-led antenatal care beyond 28 gestational weeks. Each woman in caseload care was matched with three women in regular midwife-led care, using parity, maternal age, background (Dutch or non-Dutch) and region. These two cohorts were compared for referral rates, mode of birth, and other maternal and perinatal outcomes., Results: In caseload midwifery care, 46.9% of women were referred to obstetrician-led care (24.2% antenatally and 22.8% in the intrapartum period). In the matched cohort, 65.7% were referred (37.4% antenatally and 28.3% in the intrapartum period). In caseload care, 84.0% experienced a spontaneous vaginal birth versus 77.0% in regular midwife-led care. These patterns were observed for both nulliparous and multiparous women. Women in caseload care had fewer inductions of labour (13.2% vs 21.0%), more homebirths (39.4% vs 16.1%) and less perineal damage (intact perineum: 41.3% vs 28.2%). The incidence of perinatal mortality and a low Apgar score was low in both groups., Conclusions: We found that when compared to regular midwife-led care, caseload midwifery care in the Netherlands is associated with a lower referral rate to obstetrician-led care - both antenatally and in the intrapartum period - and a higher spontaneous vaginal birth rate, with similar perinatal safety. The challenge is to include this model as part of the current effort to improve the quality of Dutch maternity care, making caseload care available and affordable for more women.

Background: Despite evidence supporting the safety of vaginal birth after caesarean section (VBAC), rates are low in many countries., Methods: OptiBIRTH investigated the effects of a woman-centred intervention designed to increase VBAC rates through an unblinded cluster randomised trial in 15 maternity units with VBAC rates < 35% in Germany, Ireland and Italy. Sites were matched in pairs or triplets based on annual birth numbers and VBAC rate, and randomised, 1:1 or 2:1, intervention versus control, following trial registration. The intervention involved evidence-based education of clinicians and women with one previous caesarean section (CS), appointment of opinion leaders, audit/peer review, and joint discussions by women and clinicians. Control sites provided usual care. Primary outcome was annual hospital-level VBAC rates before the trial (2012) versus final year of the trial (2016). Between April 2014 and October 2015, 2002 women were recruited (intervention 1195, control 807), with mode-of-birth data available for 1940 women., Results: The OptiBIRTH intervention was feasible and safe across hospital settings in three countries. There was no statistically significant difference in the change in the proportion of women having a VBAC between intervention sites (25.6% in 2012 to 25.1% in 2016) and control sites (18.3 to 22.3%) (odds ratio adjusted for differences between intervention and control groups (2012) and for homogeneity in VBAC rates at sites in the countries: 0.87, 95% CI: 0.67, 1.14, p = 0.32 based on 5674 women (2012) and 5284 (2016) with outcome data. Among recruited women with birth data, 4/1147 perinatal deaths > 24 weeks gestation occurred in the intervention group (0.34%) and 4/782 in the control group (0.51%), and two uterine ruptures (one per group), a rate of 1:1000., Conclusions: Changing clinical practice takes time. As elective repeat CS is the most common reason for CS in multiparous women, interventions that are feasible and safe and that have been shown to lead to decreasing repeat CS, should be promoted. Continued research to refine the best way of promoting VBAC is essential. This may best be done using an implementation science approach that can modify evidence-based interventions in response to changing clinical circumstances., Trial Registration: The OptiBIRTH trial was registered on 3/4/2013. Trial registration number ISRCTN10612254.

Background: Empowerment is expected to have a beneficial effect on a woman's well-being during the perinatal period and her readiness to face the challenges of motherhood. In the literature on pregnancy and childbirth, empowerment is used widely in different contexts, with different connotations and often without a definition, thus indicating a lack of clarity of what is actually meant by the concept., Objective: To report an analysis of the concept of women's empowerment in the context of the perinatal period., Methods: We used the concept analysis framework of Walker and Avant to analyse the concept of women's empowerment during pregnancy and childbirth. In July 2018, we did a systematic search in EBSCOhost, including the database MEDLINE, CINAHL, PsycINFO, PsycARTICLES and SocINDEX, using keywords: empower, women, childbirth and their synonyms. All selected papers were analysed for definitions of empowerment, defining attributes, antecedents and consequences., Results: Ninety-seven scientific papers from all continents were included in the analysis. Defining attributes, antecedents, consequences and empirical referents are discussed, and a model case as well as related and contrary cases are presented., Conclusion: Attributes, external and internal to the woman, were identified. Both types of attributes need to be considered within the broader socio-cultural-economic-political landscape of the individual woman, in conjunction with a woman's belief in herself and her meaningful interconnectedness with carers., Relevance: This study resulted in an understanding of empowerment in the context of pregnancy and childbirth that can be used in research and for the development of interventions preparing women for childbirth and their subsequent transition to motherhood., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Iceland and the Netherlands both have a long history of midwifery education and midwifery practice. Starting as a midwife requires a direct entry BSc program in midwifery in The Netherlands, where Iceland requires a nurse-midwife model. This paper presents an overview of midwifery education and its dynamic in these countries. Subsequently, we explore two most notable components that were identified as important for the future of midwifery education. In the concluding section, we reflect how these components support the scope of practice as presented in the Lancet framework for quality maternal and newborn care., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objective: reduction of physical activity (PA) during pregnancy is common but undesirable, as it is associated with negative outcomes, including excessive gestational weight gain. Our objective was to explore changes in five types of activity that occurred during pregnancy and the behavioural determinants of the reported changes in PA., Design: we performed a secondary analysis of a cross sectional survey that was constructed using the ASE-Model - an approach to identifying the factors that drive behaviour change that focuses on Attitude, Social influence, and self-Efficacy., Participants: 455 healthy pregnant women of all gestational ages, receiving prenatal care from midwifery practices in the Netherlands., Findings: more than half of our respondents reported a reduction in their PA during pregnancy. The largest reduction occurred in sports and brief rigorous activities, but other types of PA were reduced as well. Reduction of PA was more likely in women who considered themselves as active before pregnancy, women who experienced pregnancy-related barriers, women who were advised to reduce their PA, and multiparous women. Fewer than 5% increased their PA. Motivation to engage in PA was positively associated with enjoying PA., Key Conclusions and Implications for Practice: all pregnant women should be informed about the positive effects of staying active and should be encouraged to engage in, or to continue, moderately intensive activities like walking, biking or swimming. Our findings concerning the predictors of PA reduction can be used to develop an evidence-based intervention aimed at encouraging healthy PA during pregnancy., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: to study the effect of body mass index (BMI) on the use of antenatal care by women in midwife-led care., Design: an explorative cohort study., Setting: 11 Dutch midwife-led practices., Participants: a cohort of 4421 women, registered in the Midwifery Case Registration System (VeCaS), who received antenatal care in midwife-led practices in the Netherlands and gave birth between October 2012 and October 2014., Findings: the mean start of initiation of care was at 9.3 (SD 4.6) weeks of pregnancy. Multiple linear regression showed that with an increasing BMI initiation of care was significantly earlier but BMI only predicted 0.2% (R 2 ) of the variance in initiation of care. The mean number of face-to- face antenatal visits in midwife-led care was 11.8 (SD 3.8) and linear regression showed that with increasing BMI the number of antenatal visits increased. BMI predicted 0.1% of the variance in number of antenatal visits. The mean number of antenatal contacts by phone was 2.2 (SD 2.6). Multiple linear regression showed an increased number of contacts by phone for BMI categories 'underweight' and 'obese class I'. BMI categories predicted 1% of the variance in number of contacts by phone., Key Conclusions: BMI was not a relevant predictor of variance in initiation of care and number of antenatal visits. Obese pregnant women in midwife-led practices do not delay or avoid antenatal care., Implications for Practice: Taking care of pregnant women with a high BMI does not significantly add to the workload of primary care midwives. Further research is needed to more fully understand the primary maternal health services given to obese women., (Copyright © 2016 Elsevier Ltd. All rights reserved.)