Quality of care and research

Quality of care and research

Midwifery care in The Netherlands

In the Netherlands, maternity care is organised in a so called primary, secondary and tertiary care model. The primary care is provided by midwives and is intended for healthy women with an uncomplicated pregnancy. The secondary care is provided by obstetricians and clinical midwives in general hospitals and the tertiary care is provided by obstetricians and clinical midwives in academic hospitals. This type of care is intended for women with a complicated pregnancy. The care is based on the idea that a healthy woman with an uncomplicated pregnancy is best taken care of by a midwife. This minimises her chances of receiving unnecessary interventions of any kind, gives her a high standard of care and is cost-effective. A woman is accompanied in her pregnancy, birth and postnatal period by a midwife who is autonomous in her actions and decisions. Emphasis is placed on natural processes, with interventions only occurring when a problem arises. In this case, the midwife will consult or refer to an obstetrician. Risk selection, a clear distribution of tasks and a good mutual cooperation between these different strata forms the strength of the Dutch system. read more

In the pregnancy you can be referred to the obstetrician or clinical midwife if there is a higher risk of complications. Most common reasons for referral in the pregnancy are high blood pressure, feeling less movements of the baby, blood loss or different kinds of pain in the abdomen.

Most primary care midwives work in group practices, like De Bakermat. In total 96% of the women get some care of the primary midwife during pregnancy, labour or in the postpartum period. Midwifery practices have a specified working area to guard timely care. We offer prenatal consults during the week and have a midwife on call 24/7. A shift normally last 24 hours (or sometimes 48 hours). During this shift, a midwife combines both postnatal visits at home and natal care, at home or in the hospital. If she cannot visit a client in labour because she is assisting another client, she will call a colleague from her own or a neighbouring practice to attend to her client.

Choice for home or hospital birth
Low-risk women are able to choose whether to give birth at home or in the hospital. This free choice of place of birth is quite unique in the (Western) world and is an important pillar of the Dutch maternity system. If a woman decides to give birth at home, her primary care midwife will attend the birth, assisted by a maternity assistant (kraamzorg). The insurance company provides a maternity box, which contains bed protectors, maternity pads, gauze and sterilizing alcohol amongst other necessities. The midwife brings her own equipment for the birth, including medications, different medical instruments and a neonatal resuscitation set with oxygen. If complications arise, the midwife will refer to an obstetrician or paediatrician. Every hospital in the Netherlands accepts these referrals from primary care midwives. Most of the time, if a complication arises the midwife and the woman and partner can go to the hospital with their own transport. In high risk situations, midwives use ambulances for transport. Because of the good infrastructure, the median arrival time of an ambulance is ten minutes (Gezondheidsraad, 2011). The most common reason to refer a woman during birth is medicinal pain relief and/or slow progress of the first stage (16,3% of all referrals), followed by meconium stained liquor (8.8%) and prelabour rupture of membranes without contractions for more than 24 hours (4.1%) (Perined Insight LVR 1 2015). Of all referrals 1,9% is urgent.

If a low-risk woman chooses to give birth in the hospital she has to pay a contribution of about €300-400. Some health insurances cover this expense. Her birth will be attended by the primary care midwife who provided antenatal care and also attends home births. The midwife is assisted by a maternity assistant (kraamzorg). Usually, women with an uncomplicated birth leave the hospital in 2 to 4 hours after birth. Women who have an increased obstetrical risk give birth in a hospital, without extra costs to themselves. A secondary or tertiary care professional will attend them during birth. This is either a clinical midwife, a general doctor or an obstetrician in training, who will call an obstetrician if complications arise.

An extensive cohort study about the safety of planned home birth versus planned outpatient hospital birth in the Netherlands showed that a planned home birth was just as safe as a planned outpatient hospital birth. This study included nearly 530.000 low-risk women and was published in the Britisch Journal of Obstetrics & Gynaecology (BJOG, 2009).

More information is provided by the KNOV. 


De Bakermat Midwifery Practice is careful with personal details of visitors to the website. If personal details are requested, such as to register as a pregnant woman through this site, the details will be processed carefully and securely. De Bakermat complies with the requirements set out in the Personal Data Protection Act. read more

Your data and the blood test
If you decide to take the blood tests during pregnancy then your data will be used to make a diagnosis, which leads to treatment, if necessary. These data are recorded in a national registration system known as Praeventis. This makes it possible to safeguard the quality of the blood test and to monitor the process. For example, if an abnormal result was recorded but no action has been taken then the system would sound the alarm. Your obstetrician, GP, or gynaecologist would then be notified.

The data stored in Praeventis are secured according to the regulations in force. Only the person responsible for checking the quality of your treatment has access to your data. RIVM is responsible for Praeventis and for the safety of your data.
 Once the blood test has been completed, you can request that your data be removed from Praeventis. You should submit this request to your care provider.

Data on pregnancy and birth
An obstetrician, gynaecologist, or GP records data throughout the course of your pregnancy. This is vital to the effective supervision of you and your child. Data may be provided to other caregivers, but only when strictly necessary. This will be the case, for instance, if you give your permission for them to become involved in the treatment.

A number of screening programs are described in this folder. These screenings take place either during pregnancy, or shortly after birth. The purpose of these tests is the prevention or timely detection of disorders in your child. If you decide to participate in one or more tests, then the necessary data will be collected. These are vital if the screening is to be conducted effectively. They are also important for monitoring quality. These data collections each work slightly differently. This is because they each involve different care providers. However, the principle is the same in each case. Your personal data will only be used to ensure effective testing for you or your child, and to monitor the quality of the procedures involved. The data can also be used for scientific research. In almost all cases, this involves the use of anonymous data. As many precautions as possible have been taken to ensure that the data is not traceable to you or your child. In exceptional cases, scientific research requires data that is trace- able. Please tell your care provider if you do not want your data to be used in these exceptional cases. Further details are given in the special folders that accompany the various screening programs. Additional information is available on RIVM’s website.

It is important that the heel prick screening is done as soon as possible after your baby is born, so your midwife sends a birth notification to the Praeventis registration system operated by RIVM-RCP. The RIVM-RCP then instructs the local Youth Health Care organization to carry out the heel prick test. If you have already decided that you don’t want to take part in the heel prick screening, tell your midwife; your objection will be noted, and the birth notification will not be sent.

In the Netherlands, data on pregnancy and birth are also collected for other purposes. For instance, there is the Perinatal Registry, which involves input from obstetricians, GPs, gynaecologists, and paediatricians. This contains the data provided by various care providers involved in different stages of the entire process. The purpose of this registry is to improve the quality of care during pregnancy and birth. This registry is also a valuable resource for scientific research. Such research can enhance medical knowledge in the areas of pregnancy and birth. The Perinatal Registry is managed by the PRN Foundation (Netherlands Perinatal Registry).

So what is involved?
Where necessary, your obstetrician, GP, or gynaecologist will ask if you are prepared to give your permission for registration. If you decide, for whatever reason, to withhold your consent, this will of course have no influence whatsoever on the quality of your treatment. Further details concerning your privacy in the Perinatal Registry can be found in the fact sheet “Informatie voor geregistreerden, informatie voor zwangeren” (Information for registered users, information for pregnant women) at the PRN site.

Quality register/echo register

All midwives at Bakermat are BIG-registered and registered in the Quality Register for Midwives. In addition, our ultrasound technicians are registered in the Quality Register for Ultrasound Technicians. This shows that we work according to the standards of the profession and invest in the promotion of expertise.

Scientific research

To continue providing good obstetric care in the future, we participate in scientific research. This research maps current obstetric care and examines its quality. This is the prelude to further innovations. read more

National obstetric registration
In the Netherlands, most obstetricians, gynaecologists and paediatricians participate in the Perinatal Registration. This is a national database in which healthcare providers store their clients’ obstetric outcomes anonymously.

Our midwifery practice also participates in scientific research conducted by the midwifery study programme in Maastricht, the Academy of Obstetrics (AVM). VeCaS is the database of the AVM in which twenty-five obstetric practices, spread throughout the Netherlands, store their client data anonymously. In this too, you and your baby cannot be traced as a person