18 | Chapter 1 The organization of midwifery care in the Netherlands Historically, the scope of midwifery in the Netherlands is related to the law of 1865.49 This law legislated midwives only to attend deliveries that were the work of nature and forbade midwives to attend ‘abnormal’ deliveries.50 This tradition was common practice until the 1960s.50 From the 1970s, women began to prefer choosing where to deliver their children: in a hospital or at home. Therefore, outpatient births were introduced, where women give birth in a hospital accompanied by their primary care midwife and are discharged within 24 hours after birth. Furthermore, hospitals also employed midwives in a hospital setting to enhance physiology in medically indicated births.50 Midwives in the Netherlands are trained to work autonomously in maternity care.51 The majority of Dutch midwives work in the community (72%).52 They are also responsible for risk-level selection: whether women should be referred to an obstetrician based on the Obstetric Indications List (VIL). Community-based midwives mainly work selfemployed in a (group) practice in the community. They work as equal partners and hire locum midwives to cover for holidays, maternity, or sick leave. A minority of midwives (713%) work in secondary care in a hospital setting. They are responsible for women with medium and high-risk pregnancies.52 In the hospital setting, the tasks and responsibilities between obstetricians and clinical midwives are divided, with midwives being autonomously responsible for some tasks according to strict protocols and working under supervision of an obstetrician for others.53 Hospital-based midwives are in charge of the delivery rooms most of the time and delegate some tasks to obstetric nurses. They bridge the gap between primary-care midwives and obstetricians.53 In the Netherlands, a trend over the last decades is that NQMs work as a locum midwife (72%) and a minority work as a partner in a community practice (4%).36 Until 2005, these percentages were different: 0-5% of the NQMs worked as a locum, and 20-45% worked as a partner in a midwifery practice or hospital-based (10-25%) or were not working as a midwife (2060%)36Job-seeking midwives largely wanted to work in a partnership in a communitybased midwifery practice (58%).36 Midwifery education in the Netherlands Students are educated in a four-year direct-entry midwifery programme at a university of applied sciences. Three different universities offer a Bachelor of Science midwifery programme, and 220 students start the programme annually. The inflow of student midwives is regulated by the government through a numerus fixus (a restriction of the number of places on offer on popular and costly degree programmes).51 The professional
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