Perceived job demands and resources of newly qualified midwives working in primary care settings in the Netherlands | 27 INTRODUCTION Performing as a newly qualified midwife (NQM) in midwifery practice is challenging and demanding.1 Newly qualified midwives are fully responsible and accountable for providing care to their clients from the moment of graduation (or registration).2 International research shows that the weight of responsibilities in the first year of practice can negatively influence NQMs’ professional confidence as well as the overall quality of the provided care.3,4 Further to the outcomes of international research studies, NQMs in the Netherlands are likely to face a number of additional challenges due to the specific Dutch context. First, in Dutch primary midwifery care, midwives work independently in providing pre- and postnatal care, and during labor and birth. The primary care midwife is the professional in charge for low–risk pregnant women.5 Second, NQMs in other countries are supported in their transition from student to registered midwife.1,6,7 In the Netherlands, formal support programs for NQMs do not exist. Third, in the Netherlands 72 percent of NQMs work as a locum midwife (explained in textbox 1) in primary care during their first years in practice,8 as opposed to most other developed countries, where NQMs are usually employed by a hospital and work in a hospital setting.1,6,9 Within the Dutch midwifery care system, primary care midwives refer pregnant women to obstetricians when complications arise. Over the past decade, referral rates have been increasing which could partly be attributed to midwives’ attitudes due to feelings of insecurity and anxiety.10 These increasing referral rates could threaten in the long term the unique choice for women in the Netherlands to give birth at home. Primary care midwifery practices hire a locum midwife to cover for holiday, maternity or sick leave. Locum midwives are self-employed. In order to be recognized as selfemployed (“autonomous professional without personnel”) by the Dutch tax agency, locum midwives are required to work for a number of different midwifery practices, to demonstrate their in- dependence.11 International studies on NQMs show that factors such as reality shock,12 applying a different midwifery philosophy of care,13,14 and delay in securing employment and work allocations make the first years a very demanding period for NQMs.15 Studies on work resources for NQMs show that positive support and mentorship from colleagues,1,15 working in continuity of care models,16,17 and postgraduate preceptorship programs are associated with increasing confidence and competence.1,14
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