TY - JOUR
T1 - Less or more? Maternal requests that go against medical advice
AU - Hollander, Martine
AU - Holten, Lianne
AU - Leusink, Annemieke
AU - van Dillen, Jeroen
AU - de Miranda, Esteriek
PY - 2018
Y1 - 2018
N2 - Problem and background: This study explores the experiences of Dutch midwives and gynaecologists with pregnant women who request more, less or no care during pregnancy and/or childbirth. Methods: All Dutch midwives and (trainee) gynaecologists were invited to fill out a questionnaire specifically designed for the purposes of this study. Holistic midwives were analysed separately from regular community midwives. Findings: Most maternity care providers in the Netherlands receive requests for less care than recommended at least once a year. The most frequently maternal requests were declining testing for gestational diabetes (66.3%), opting for a home birth in case of a high risk pregnancy (65.3%), and declining foetal monitoring during labour (39.6%). Holistic midwives are more convinced of an increasing demand for less care than community midwives (73.1% vs. 35.2%, p = <0.001). More community midwives than hospital staff reported to have declined one or more request for less care than recommended (48.6% vs. 27.9%, p = <0.001). The majority of hospital staff also receive at least one request for an elective caesarean section every year. Discussion and conclusion: Requests for more and less care than indicated during pregnancy and childbirth are equally prevalent in this study. However, a request for less care is more likely to be declined than a request for more care. Counselling women who disagree with their care provider demands time. In case of requests for less care, second best care should be considered.
AB - Problem and background: This study explores the experiences of Dutch midwives and gynaecologists with pregnant women who request more, less or no care during pregnancy and/or childbirth. Methods: All Dutch midwives and (trainee) gynaecologists were invited to fill out a questionnaire specifically designed for the purposes of this study. Holistic midwives were analysed separately from regular community midwives. Findings: Most maternity care providers in the Netherlands receive requests for less care than recommended at least once a year. The most frequently maternal requests were declining testing for gestational diabetes (66.3%), opting for a home birth in case of a high risk pregnancy (65.3%), and declining foetal monitoring during labour (39.6%). Holistic midwives are more convinced of an increasing demand for less care than community midwives (73.1% vs. 35.2%, p = <0.001). More community midwives than hospital staff reported to have declined one or more request for less care than recommended (48.6% vs. 27.9%, p = <0.001). The majority of hospital staff also receive at least one request for an elective caesarean section every year. Discussion and conclusion: Requests for more and less care than indicated during pregnancy and childbirth are equally prevalent in this study. However, a request for less care is more likely to be declined than a request for more care. Counselling women who disagree with their care provider demands time. In case of requests for less care, second best care should be considered.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85044652727&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29439923
U2 - 10.1016/j.wombi.2018.01.010
DO - 10.1016/j.wombi.2018.01.010
M3 - Article
C2 - 29439923
VL - 31
SP - 505
EP - 512
JO - Women and birth
JF - Women and birth
SN - 1871-5192
IS - 6
ER -