General discussion | 193 at a variety of perspectives (work environment, occupational wellbeing, and transition support). Moreover, a variety of methods were used. The consecutive steps in the qualitative and quantitative studies provided opportunities to enrich the data collection and data analysis over the next steps. All studies were conducted by a multidisciplinary research team with experienced researchers in different fields: general and veterinary medicine, midwifery, and educational and psychological sciences, which has made this study more robust. The different perspectives on research on healthcare professions and the scope of primary care have contributed to the quality of all studies in this thesis. Our studies also have limitations. Exploratory research was conducted, as there was little existing research on midwives in the maternity care context of the Netherlands. We could only establish associations, which are more limited connections than causal relationships. Another limitation of this thesis was the small population of NQMs in the Netherlands. We were therefore limited in our multivariable statistical analysis of the determinants of wellbeing. Another limitation is the generalizability of our findings. Although we included a quarter of the population of midwives in the Netherlands, the generalizability for hospital-based midwives is limited, due to the limited number of hospital-based midwives in our sample. Furthermore, by focusing on midwives within one country, we might have limited the international generalizability of our findings. For instance, the work environment of NQMs and experienced midwives in the Netherlands differs from the work environment of midwives in other countries, as they work mainly in hospitals. However, our study does contribute to the existing knowledge of community-based NQMs. Our findings may provide tentative indications for the wellbeing and transitioninto-practice of NQMs and midwives in midwifery-led settings in other countries. Both a strength and a limitation of our studies is the choice for the burnout measurement scale, the Utrecht Burnout Scale. Using this scale, we were able to compare our findings with several national and European findings on occupational wellbeing. However, as a result of this choice, the Burnout Scale differs from the one used in most global studies of midwives’ wellbeing.21 Other studies on midwives’ wellbeing internationally mainly used a different measurement instrument: the Copenhagen Burnout Inventory.
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