How to Make the Hospital an Option Again: Midwives’ and Obstetricians’ Experiences with a Designated Clinic for Women Who Request Different Care than Recommended in the Guidelines

Background: An increasing number of maternity care providers encounter pregnant women who request less care than recommended. A designated outpatient clinic for women who request less care than recommended was set up in Nijmegen, the Netherlands. The clinic’s aim is to ensure that women make well-in...

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Autores principales:	Floor Opdam, Jeroen van Dillen, Marieke de Vries, Martine Hollander
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	maternity care personalised care woman-centred care high risk care outside the guidelines treatment refusal Medicine R
Acceso en línea:	https://doaj.org/article/82340d5cc6794ef7abbbcb99787609a4
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spelling	oai:doaj.org-article:82340d5cc6794ef7abbbcb99787609a42021-11-11T16:43:51ZHow to Make the Hospital an Option Again: Midwives’ and Obstetricians’ Experiences with a Designated Clinic for Women Who Request Different Care than Recommended in the Guidelines10.3390/ijerph1821116271660-46011661-7827https://doaj.org/article/82340d5cc6794ef7abbbcb99787609a42021-11-01T00:00:00Zhttps://www.mdpi.com/1660-4601/18/21/11627https://doaj.org/toc/1661-7827https://doaj.org/toc/1660-4601Background: An increasing number of maternity care providers encounter pregnant women who request less care than recommended. A designated outpatient clinic for women who request less care than recommended was set up in Nijmegen, the Netherlands. The clinic’s aim is to ensure that women make well-informed choices and arrive at a care plan that is acceptable to all parties. The aim of this study is to make the clinic’s approach explicit by examining care providers’ experiences who work with or within the clinic. Methods: qualitative analysis of in-depth interviews with Dutch midwives (<i>n</i> = 6) and obstetricians (<i>n</i> = 4) on their experiences with the outpatient clinic “Maternity Care Outside the Guidelines” in Nijmegen, the Netherlands. Results: Four main themes were identified: (1) ”Trusting mothers, childbirth and colleagues”; (2) “A supportive communication style”; (3) “Continuity of carer”; (4) “Willingness to reconsider responsibility and risk”. One overarching theme emerged from the data, which was “Guaranteeing women’s autonomy”. Mutual trust is a prerequisite for a constructive dialogue about birth plans and can be built and maintained more easily when there is continuity of carer during pregnancy and birth. Discussing birth plans at the clinic was believed to be successful because the care providers listen to women, take them seriously, show empathy and respect their right to refuse care. A change in vision on responsibility and risk is needed to overcome barriers such as providers’ fear of adverse outcomes. Taking a more flexible approach towards care outside the guidelines demands courage but is necessary to guarantee women’s autonomy. Key conclusions and implications for practice: In order to fulfil women’s needs and to prevent negative choices, care providers should care for women with trust, respect for autonomy, and provide freedom of choice and continuity. Care providers should reflect on and discuss why they are reluctant to support women’s wishes that go against their personal values. The structured approach used at this clinic could be helpful to maternity care providers in other contexts, to make them feel less vulnerable when working outside the guidelines.Floor OpdamJeroen van DillenMarieke de VriesMartine HollanderMDPI AGarticlematernity carepersonalised carewoman-centred carehigh riskcare outside the guidelinestreatment refusalMedicineRENInternational Journal of Environmental Research and Public Health, Vol 18, Iss 11627, p 11627 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	maternity care personalised care woman-centred care high risk care outside the guidelines treatment refusal Medicine R
spellingShingle	maternity care personalised care woman-centred care high risk care outside the guidelines treatment refusal Medicine R Floor Opdam Jeroen van Dillen Marieke de Vries Martine Hollander How to Make the Hospital an Option Again: Midwives’ and Obstetricians’ Experiences with a Designated Clinic for Women Who Request Different Care than Recommended in the Guidelines
description	Background: An increasing number of maternity care providers encounter pregnant women who request less care than recommended. A designated outpatient clinic for women who request less care than recommended was set up in Nijmegen, the Netherlands. The clinic’s aim is to ensure that women make well-informed choices and arrive at a care plan that is acceptable to all parties. The aim of this study is to make the clinic’s approach explicit by examining care providers’ experiences who work with or within the clinic. Methods: qualitative analysis of in-depth interviews with Dutch midwives (<i>n</i> = 6) and obstetricians (<i>n</i> = 4) on their experiences with the outpatient clinic “Maternity Care Outside the Guidelines” in Nijmegen, the Netherlands. Results: Four main themes were identified: (1) ”Trusting mothers, childbirth and colleagues”; (2) “A supportive communication style”; (3) “Continuity of carer”; (4) “Willingness to reconsider responsibility and risk”. One overarching theme emerged from the data, which was “Guaranteeing women’s autonomy”. Mutual trust is a prerequisite for a constructive dialogue about birth plans and can be built and maintained more easily when there is continuity of carer during pregnancy and birth. Discussing birth plans at the clinic was believed to be successful because the care providers listen to women, take them seriously, show empathy and respect their right to refuse care. A change in vision on responsibility and risk is needed to overcome barriers such as providers’ fear of adverse outcomes. Taking a more flexible approach towards care outside the guidelines demands courage but is necessary to guarantee women’s autonomy. Key conclusions and implications for practice: In order to fulfil women’s needs and to prevent negative choices, care providers should care for women with trust, respect for autonomy, and provide freedom of choice and continuity. Care providers should reflect on and discuss why they are reluctant to support women’s wishes that go against their personal values. The structured approach used at this clinic could be helpful to maternity care providers in other contexts, to make them feel less vulnerable when working outside the guidelines.
format	article
author	Floor Opdam Jeroen van Dillen Marieke de Vries Martine Hollander
author_facet	Floor Opdam Jeroen van Dillen Marieke de Vries Martine Hollander
author_sort	Floor Opdam
title	How to Make the Hospital an Option Again: Midwives’ and Obstetricians’ Experiences with a Designated Clinic for Women Who Request Different Care than Recommended in the Guidelines
title_short	How to Make the Hospital an Option Again: Midwives’ and Obstetricians’ Experiences with a Designated Clinic for Women Who Request Different Care than Recommended in the Guidelines
title_full	How to Make the Hospital an Option Again: Midwives’ and Obstetricians’ Experiences with a Designated Clinic for Women Who Request Different Care than Recommended in the Guidelines
title_fullStr	How to Make the Hospital an Option Again: Midwives’ and Obstetricians’ Experiences with a Designated Clinic for Women Who Request Different Care than Recommended in the Guidelines
title_full_unstemmed	How to Make the Hospital an Option Again: Midwives’ and Obstetricians’ Experiences with a Designated Clinic for Women Who Request Different Care than Recommended in the Guidelines
title_sort	how to make the hospital an option again: midwives’ and obstetricians’ experiences with a designated clinic for women who request different care than recommended in the guidelines
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/82340d5cc6794ef7abbbcb99787609a4
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How to Make the Hospital an Option Again: Midwives’ and Obstetricians’ Experiences with a Designated Clinic for Women Who Request Different Care than Recommended in the Guidelines

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