Currently, 13 years later, seven more midwives have successfully defended their dissertations and earned a PhD and more are in the final stages of their doctoral studies and some have made the first steps on the path towards a PhD.
A Masters of Science in midwifery programme was established in 2003 and about 60 midwives have successfully completed this to date. The KNOV has expanded its quality division and has initiated and participated in research studies and has carried out its own research projects. TNO has broadened its scope of work and is carrying out a number of qualitative studies besides epidemiological studies.
Recently, several papers were published about the referral system (e.g. Amelink-Verburg et al. 2008), home delivery (e.g. de Jonge et al. 2009), the experience of women (Rijnders et al. 2008a) and the content of midwifery care (e.g. Rijnders et al. 2008b). Thus, there has been considerable development in Dutch first-line midwifery in a short period, but there is still a great need for an evidence base for midwifery practice in the Netherlands.
undertaken by other professionals; not only as data suppliers but also in the development phase when formulating research questions and outcome measures and basic principles for a literature search. The example of the Anaemia Standard (section 5) shows that a search carried out with a physiological perspective can result in unexpected findings.
Conclusion
Dutch obstetrics/midwifery is an outstanding example of the conception and development of ‘evidence based midwifery’.
The first condition for this is the realisation of the importance of this scientific domain throughout the entire profession including individual midwives, as they are the ones to argue the case to researchers and funding agencies. In this, there is no lack of enthusiasm, but that alone is not sufficient. It will need knowledge, daring and assertiveness. The midwifery educational programmes fulfil a crucial role in this realisation as they shape the midwives of the future in knowledge, as well as in attitude.
The second condition is a funding increase for research in the area of physio-logical obstetrics/midwifery. Although much progress has been made in the last decade, it has gone too slowly and is still not sufficient. In the Netherlands, most of the midwife researchers have no choice but to carry out their research activities in their own time, combining it with their regular employment or work. Because of this, the research process is slow and it takes more time to achieve results.
Many research questions are not incorporated into grant programmes because they do not conform to the strict programme criteria. Midwives should be more involved in defining the criteria of grant programmes.
The third condition is visibility. The midwifery profession is still struggling with gender issues. This is caused by both the gender composition of the pro-fession (98% women) as well as the (still) existing hierarchical relationship with obstetricians. Midwives must stand up and deliver. They should publish and present. They need to manifest their knowledge and quality. This demands a daring that too often is not present, and the midwifery educational programmes could play an important role in this area. It does not stop with the midwifery schools: lifelong learning is essential because ‘the person who stops improving, stops excelling’ (van Veen 2006).
The overarching condition is the combining of strengths. Only when this is achieved can the other conditions be met and this should have the highest priority. The previously mentioned developments and initiatives are important and promising, but these are still too fragmented and without enough sustenance for Dutch midwifery to ‘make a fist’. It is high time for a Centre of Expertise for physiological obstetrics/midwifery, with a dedicated chair position for a professor in evidence based midwifery. In 2009, preparations are being made in three Dutch universities to realise such a chair. Within this dedicated place, groups of researchers could combine expertise and vision and stimulate and motivate each other. It could facilitate structured contact and exchange with similar research
groups from abroad. It could be the place where evidence based midwifery could really develop and take shape. Here applies the same principle of joining together loose ends to make one strong thematic thread; one plus one is greater than two.
In closing
The Dutch midwifery profession still has a long way to go on its journey towards evidence based midwifery. The Dutch midwives can find motivation for this journey in the vision of their profession: the conviction that pregnancy and birth are, in principle, physiological events in which unnecessary interventions must be prevented (Liefhebber et al. 2006).
On this journey, Dutch midwives can (and should) look for support from their colleagues abroad. Despite the immense differences in the circumstances of midwives throughout the world, they are all united in the international definition of the midwife as formulated by the International Confederation of Midwives.
The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant.
(ICM Council Meeting 2005)
This definition unites Dutch midwives with their international colleagues.
It unites the midwives of today with the Catharina Schraders from the past and reinforces with evidence based midwifery; it will hopefully be a source of inspiration for the midwives in the future.
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