Registering Dutch midwifery care: lessons to be learned

1
Registering Dutch midwifery care lessons to be
learned
Kathy Herschdefer Mariannne Amelink-Verburg
2

• If the world should perish, I will move to the
  Netherlands where everything occurs fifty years
  later.

Heinrich Heine
3
The Netherlands has a unique system of obstetric
care

• Distinction between physiology and pathology
• Two levels of obstetric care
• Primary level provided by midwife with home birth
  as option
• Secondary level provided by obstetrician

4
Three national perinatal registration systems in
the Netherlands

• LVR-1
• primary care obstetrics independent midwife and
  GP
• LVR-2
• secondary care obstetricsobstetrician and
  midwife
• LNR
• neonatal careneonatologist and paediatrician

5
Participation in national obstetric registration
systems

• Caregivers
• 94 midwifery practices
• 97 obstetric partnerships
• Registered cases (2002) 204,284
• 160,912 in LVR-1 (79)
• 122,783 in LVR-2 (60)

6
Characteristics of LVR-1

• Registration of process within the obstetrical
  care system
• Emphasis on consultations and referrals to and
  from secondary care
• (Limited) registration of birth process

7
Characteristics of LVR-2

• Registration of interventions
• Emphasis on medical facts
• (Limited) registration of birth process

8
Births in the Netherlands in 2000 by level of
caregiver
pregnancy starting pregnancy starting in
secondary care in primary care 15
85 referral to secondary care during
pregnancy births starting 28 in
primary care 57 referral to
secondary care during birth 17 births
in secondary care births in primary care
60 40
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Definition of Normal birth

• Starting labour without induction
• Unassisted vaginal delivery

10
Normal birth in the Netherlands (PERISTAT data)

• 1999 201,389 cases
• Spontaneous onset labour 79
• Spontaneous unassisted birth 73
• Normal birth 63

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Future of midwifery and obstetric registration
systems in the Netherlands

• Unique identification number
• Shared minimal data set
• Room for extra (trend) information, e.g.
• specific for the profession
• specific for a region
• specific for a particular topic