72 | Chapter 4 2. What are the determinants of burnout symptoms and high work engagement in Dutch midwives and do these differ between newly qualified and experienced midwives? With the outcomes of this study, we aim to contribute to the knowledge about the occupational wellbeing of midwives. Based on an understanding of the determinants of midwives’ wellbeing, we make tailored recommendations for optimising that wellbeing, thereby contributing to the quality of midwifery care. Midwifery care in the Netherlands Dutch maternity care is strictly divided into primary and secondary midwifery care, whereby primary care midwives care for women with low-risk pregnancies and secondary care midwives take care of women with mid- and high-risk pregnancies under the supervision of an obstetrician. NQMs choose either employment at a hospital or selfemployment in the community. Almost 75 percent of Dutch NQMs work in the community after graduation, with about 70% working as locum midwives.31 Primary care midwifery practices hire a locum midwife to cover for holiday, maternity or sick leave. Locum midwives are self-employed. To be recognised as self-employed (‘autonomous professional without personnel’) by the Dutch tax agency, locum midwives are required to work for different midwifery practices in one year in order to demonstrate their independence. Nowadays, the way maternity care is organized tends to reduce the boundaries between primary and secondary care, which could adversely influence the level of work autonomy for primary care midwives.47 Registered Dutch midwives hold a BSc. degree from a university of applied science. This four-year programme allows them to register in the Ministry of Health’s BIG register. The BIG register is a governmental body which entitles healthcare providers to practice in the Netherlands. PhD tracks have been developed at the midwifery academies in cooperation with associated universities. For a Master’s degree, midwives are dependent on generic Master's programmes in research or health sciences. PARTICIPANTS, ETHICS AND METHODS In December 2018- March 2019, a cross-sectional study was conducted among newly qualified and experienced practising midwives in the Netherlands using a questionnaire with validated scales. Dependent variables were burnout symptoms and work
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