Experiences and views of midwives performing antenatal cardiotocography in Dutch primary care: A qualitative study.

MSG van der Pijl, EQ Tiel Groenestege, CJM Verhoeven

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective: In the current Dutch maternity care system, pregnant women who have an indication for an antenatal cardiotocography (CTG) to be undertaken need to be referred from primary midwife-led care to secondary obstetric-led care. Within three different regions in the Netherlands independent primary care midwives perform antenatal CTG in primary care, introduced as a pilot project. The aim of this study was to evaluate the experiences and views of primary care midwives who perform antenatal CTG in primary care. Design: Using a qualitative approach data were collected by seventeen in depth semi-structured interviews. The interview recordings were transcribed verbatim and analysed using thematic coding. Setting: Three regions in the Netherlands where midwives carry out antenatal CTG in primary care during this pilot project. Participants: Seventeen primary care midwives were interviewed between July and November 2017. Findings: In general, midwives were satisfied with performing antenatal CTG and felt it contributed positively towards the midwife-client relationship. However, midwives experienced an increased workload, partly due to time-consuming technical difficulties. Furthermore, mixed feelings existed on whether antenatal CTG contributes to a more physiological or to a more pathological approach in midwifery practice. Most midwives believed that performing antenatal CTG contributes to the physiological process: strengthening of their gate-keeper role, increased confidence of their clients and improved midwife-client relationship. In contrast, some midwives believed it contributes to a pathological process: medicalization and relying too much on technical devices. Key conclusions: This study showed an overall positive attitude of primary care midwives towards performing antenatal CTG when required, in primary midwife-led care. However, performing the antenatal CTG can be a challenge for midwives, as midwifery care within this setting is often for healthy women who have a straightforward pregnancy. For some midwives, providing antenatal CTG monitoring in the primary care setting may be seen as using a pathological approach to midwifery care. Implications for practice: There seems to be a place for antenatal CTG in primary midwife-led care. However, further research is needed before this practice can be implemented widely.

Original languageEnglish
Pages (from-to)60-66
Number of pages7
JournalMidwifery
Volume72
DOIs
Publication statusPublished - 1 May 2019

Cite this

@article{b51e9bc297d144b79eb9e8ccd210f99a,
title = "Experiences and views of midwives performing antenatal cardiotocography in Dutch primary care: A qualitative study.",
abstract = "Objective: In the current Dutch maternity care system, pregnant women who have an indication for an antenatal cardiotocography (CTG) to be undertaken need to be referred from primary midwife-led care to secondary obstetric-led care. Within three different regions in the Netherlands independent primary care midwives perform antenatal CTG in primary care, introduced as a pilot project. The aim of this study was to evaluate the experiences and views of primary care midwives who perform antenatal CTG in primary care. Design: Using a qualitative approach data were collected by seventeen in depth semi-structured interviews. The interview recordings were transcribed verbatim and analysed using thematic coding. Setting: Three regions in the Netherlands where midwives carry out antenatal CTG in primary care during this pilot project. Participants: Seventeen primary care midwives were interviewed between July and November 2017. Findings: In general, midwives were satisfied with performing antenatal CTG and felt it contributed positively towards the midwife-client relationship. However, midwives experienced an increased workload, partly due to time-consuming technical difficulties. Furthermore, mixed feelings existed on whether antenatal CTG contributes to a more physiological or to a more pathological approach in midwifery practice. Most midwives believed that performing antenatal CTG contributes to the physiological process: strengthening of their gate-keeper role, increased confidence of their clients and improved midwife-client relationship. In contrast, some midwives believed it contributes to a pathological process: medicalization and relying too much on technical devices. Key conclusions: This study showed an overall positive attitude of primary care midwives towards performing antenatal CTG when required, in primary midwife-led care. However, performing the antenatal CTG can be a challenge for midwives, as midwifery care within this setting is often for healthy women who have a straightforward pregnancy. For some midwives, providing antenatal CTG monitoring in the primary care setting may be seen as using a pathological approach to midwifery care. Implications for practice: There seems to be a place for antenatal CTG in primary midwife-led care. However, further research is needed before this practice can be implemented widely.",
keywords = "Antenatal cardiotocography, Antenatal care, Electronic foetal monitoring, Midwife, Primary health care",
author = "{van der Pijl}, MSG and {Tiel Groenestege}, EQ and CJM Verhoeven",
year = "2019",
month = "5",
day = "1",
doi = "10.1016/j.midw.2019.02.003",
language = "English",
volume = "72",
pages = "60--66",
journal = "Midwifery",
issn = "0266-6138",
publisher = "Churchill Livingstone",

}

Experiences and views of midwives performing antenatal cardiotocography in Dutch primary care: A qualitative study. / van der Pijl, MSG; Tiel Groenestege, EQ; Verhoeven, CJM.

In: Midwifery, Vol. 72, 01.05.2019, p. 60-66.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Experiences and views of midwives performing antenatal cardiotocography in Dutch primary care: A qualitative study.

AU - van der Pijl, MSG

AU - Tiel Groenestege, EQ

AU - Verhoeven, CJM

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Objective: In the current Dutch maternity care system, pregnant women who have an indication for an antenatal cardiotocography (CTG) to be undertaken need to be referred from primary midwife-led care to secondary obstetric-led care. Within three different regions in the Netherlands independent primary care midwives perform antenatal CTG in primary care, introduced as a pilot project. The aim of this study was to evaluate the experiences and views of primary care midwives who perform antenatal CTG in primary care. Design: Using a qualitative approach data were collected by seventeen in depth semi-structured interviews. The interview recordings were transcribed verbatim and analysed using thematic coding. Setting: Three regions in the Netherlands where midwives carry out antenatal CTG in primary care during this pilot project. Participants: Seventeen primary care midwives were interviewed between July and November 2017. Findings: In general, midwives were satisfied with performing antenatal CTG and felt it contributed positively towards the midwife-client relationship. However, midwives experienced an increased workload, partly due to time-consuming technical difficulties. Furthermore, mixed feelings existed on whether antenatal CTG contributes to a more physiological or to a more pathological approach in midwifery practice. Most midwives believed that performing antenatal CTG contributes to the physiological process: strengthening of their gate-keeper role, increased confidence of their clients and improved midwife-client relationship. In contrast, some midwives believed it contributes to a pathological process: medicalization and relying too much on technical devices. Key conclusions: This study showed an overall positive attitude of primary care midwives towards performing antenatal CTG when required, in primary midwife-led care. However, performing the antenatal CTG can be a challenge for midwives, as midwifery care within this setting is often for healthy women who have a straightforward pregnancy. For some midwives, providing antenatal CTG monitoring in the primary care setting may be seen as using a pathological approach to midwifery care. Implications for practice: There seems to be a place for antenatal CTG in primary midwife-led care. However, further research is needed before this practice can be implemented widely.

AB - Objective: In the current Dutch maternity care system, pregnant women who have an indication for an antenatal cardiotocography (CTG) to be undertaken need to be referred from primary midwife-led care to secondary obstetric-led care. Within three different regions in the Netherlands independent primary care midwives perform antenatal CTG in primary care, introduced as a pilot project. The aim of this study was to evaluate the experiences and views of primary care midwives who perform antenatal CTG in primary care. Design: Using a qualitative approach data were collected by seventeen in depth semi-structured interviews. The interview recordings were transcribed verbatim and analysed using thematic coding. Setting: Three regions in the Netherlands where midwives carry out antenatal CTG in primary care during this pilot project. Participants: Seventeen primary care midwives were interviewed between July and November 2017. Findings: In general, midwives were satisfied with performing antenatal CTG and felt it contributed positively towards the midwife-client relationship. However, midwives experienced an increased workload, partly due to time-consuming technical difficulties. Furthermore, mixed feelings existed on whether antenatal CTG contributes to a more physiological or to a more pathological approach in midwifery practice. Most midwives believed that performing antenatal CTG contributes to the physiological process: strengthening of their gate-keeper role, increased confidence of their clients and improved midwife-client relationship. In contrast, some midwives believed it contributes to a pathological process: medicalization and relying too much on technical devices. Key conclusions: This study showed an overall positive attitude of primary care midwives towards performing antenatal CTG when required, in primary midwife-led care. However, performing the antenatal CTG can be a challenge for midwives, as midwifery care within this setting is often for healthy women who have a straightforward pregnancy. For some midwives, providing antenatal CTG monitoring in the primary care setting may be seen as using a pathological approach to midwifery care. Implications for practice: There seems to be a place for antenatal CTG in primary midwife-led care. However, further research is needed before this practice can be implemented widely.

KW - Antenatal cardiotocography

KW - Antenatal care

KW - Electronic foetal monitoring

KW - Midwife

KW - Primary health care

UR - http://www.scopus.com/inward/record.url?scp=85061621448&partnerID=8YFLogxK

U2 - 10.1016/j.midw.2019.02.003

DO - 10.1016/j.midw.2019.02.003

M3 - Article

VL - 72

SP - 60

EP - 66

JO - Midwifery

JF - Midwifery

SN - 0266-6138

ER -