Addressing a need. Holistic midwifery in the Netherlands: A qualitative analysis

PLoS One. 2019 Jul 30;14(7):e0220489. doi: 10.1371/journal.pone.0220489. eCollection 2019.

Abstract

The Netherlands has a maternity care system with integrated midwifery care, including the option of home birth for low risk women. A small group of Dutch (holistic) midwives is willing to assist women in high risk pregnancies during a home birth against medical advice. We examined holistic midwives' motivations and way of practice, in order to provide other maternity care professionals with insight into the way they work and to improve professional relationships between all care providers in the field. An exploratory qualitative research design with a constructivist approach and a grounded theory method were used. We performed in-depth interviews with twenty-four holistic midwives on their motivations for working outside their professional boundaries. Open, axial and selective coding of the interview data was done in order to generate themes. We held a focus group for a member check of the findings. Four main themes were found: 1) The regular system is failing women, 2) The relationship as basis for empowerment, 3) Delivering client centered care in the current system is demanding, and 4) Future directions. One core theme emerged that covered all other themes: Addressing a need. Holistic midwives explained that many of their clients had no other choice than to choose a home birth in a high risk pregnancy because they felt let down by the regular system of maternity care. Holistic midwives appear to deliver an important service. They provide continuity of care and succeed in establishing a relationship with their clients built on trust and mutual respect, truly putting their clients' needs first. Some women feel let down by the regular system, and holistic midwives may be the last resort before those women choose to deliver unattended by any medical professional. Maternity care providers should consider working with holistic midwives in the interest of good patient care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Attitude of Health Personnel
  • Female
  • Health Promotion
  • Holistic Health*
  • Humans
  • Maternal Health Services / organization & administration*
  • Middle Aged
  • Midwifery / organization & administration*
  • Midwifery / standards
  • Midwifery / statistics & numerical data
  • Needs Assessment*
  • Netherlands
  • Pregnancy
  • Qualitative Research
  • Surveys and Questionnaires
  • Young Adult

Grants and funding

MH’s travel expenses to conduct the interviews were re-embursed by her employer, the department of obstetrics at the Radboud University Medical Center, Nijmegen, the Netherlands. LH’s travel expenses to conduct the interviews were re-embursed by her employer, AVAG school of midwifery, Amsterdam, the Netherlands. The Academic Medical Center, and AVAG school of midwifery, both in Amsterdam, the Netherlands supplied enough funding for a professional agency to transcribe approximately one-third of the interviews. The other interviews were transcribed by volunteer medical students. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.