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Open Access Research article

Improving interprofessional coordination in Dutch midwifery and obstetrics: a qualitative study

Vera LN Schölmerich12*, Anke G Posthumus1, Halleh Ghorashi3, Adja JM Waelput1, Peter Groenewegen2 and Semiha Denktaş1

Author Affiliations

1 Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Westzeedijk 118, Rotterdam 3016 AH, The Netherlands

2 Department of Organizational Sciences, VU University Amsterdam, De Boelelaan 1081, Amsterdam 1081 HV, The Netherlands

3 Department of Sociology, VU University Amsterdam, De Boelelaan 1081, Amsterdam 1081 HV, The Netherlands

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BMC Pregnancy and Childbirth 2014, 14:145  doi:10.1186/1471-2393-14-145

Published: 15 April 2014

Abstract

Background

Coordination between the autonomous professional groups in midwifery and obstetrics is a key debate in the Netherlands. At the same time, it remains unclear what the current coordination challenges are.

Methods

To examine coordination challenges that might present a barrier to delivering optimal care, we conducted a qualitative field study focusing on midwifery and obstetric professional’s perception of coordination and on their routines. We undertook 40 interviews with 13 community midwives, 8 hospital-based midwives and 19 obstetricians (including two resident obstetricians), and conducted non-participatory observations at the worksite of these professional groups.

Results

We identified challenges in terms of fragmented organizational structures, different perspectives on antenatal health and inadequate interprofessional communication. These challenges limited professionals' coordinating capacity and thereby decreased their ability to provide optimal care. We also found that pregnant women needed to compensate for suboptimal coordination between community midwives and secondary caregivers by taking on an active role in facilitating communication between these professionals.

Conclusions

The communicative role that pregnant women play within coordination processes underlines the urgency to improve coordination. We recommend increasing multidisciplinary meetings and training, revising the financial reimbursement system, implementing a shared maternity notes system and decreasing the expertise gap between providers and clients. In the literature, communication by clients in support of coordination has been largely ignored. We suggest that studies include client communication as part of the coordination process.

Keywords:
Interprofessional coordination; Prenatal health; Antenatal health; Midwifery and obstetrics; Maternal health care; Coordination practices