title: "A mixture of positive and negative feelings": a qualitative study of primary care midwives' experiences with non-western clients living in the Netherlands.
abstract: BACKGROUND
  Non-western women living in the Netherlands are diverse in origin, which implies diversity in their needs and expectations for midwifery care. Furthermore, it has also been shown that non-western women make suboptimal use of prenatal care. Midwives may therefore face difficulties when caring for these clients.
  
  
  OBJECTIVE
  The main objective of our study was to explore Dutch primary care midwives' experiences with non-western clients.
  
  
  METHODS
  A qualitative design was used. Thirteen midwives were interviewed individually and 8 participated in a focus group. All interviews were transcribed and analysed by two researchers who compared and discussed their results. Analytical codes were organised into subthemes and main themes.
  
  
  RESULTS
  Midwives perceived ethnic diversity as both difficult and interesting. Caring for these women was perceived as demanding, but also rewarding. They experienced a variety of difficulties when caring for these women: communication problems, suboptimal health literacy, socioeconomic problems, lack of knowledge of the maternity care system, pressure from the family and a strong preference for physicians. In spite of these difficulties, midwives aim for optimal care by being alert and proactive, taking these women by the hand and making use of alternative resources.
  
  
  CONCLUSIONS
  Provision of care to non-western clients can be difficult and may require additional measures. These problems and measures should be included in midwifery education programmes as well as training programmes for midwives.
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN Utrecht, The Netherlands. Electronic address: a.boerleider@nivel.nl.
authors.forename: Agatha W
authors.initials: AW
authors.lastname: Boerleider
authors.forename: Anneke L
authors.initials: AL
authors.lastname: Francke
authors.forename: Judith
authors.initials: J
authors.lastname: Manniën
authors.forename: Therese A
authors.initials: TA
authors.lastname: Wiegers
authors.forename: Walter L J M
authors.initials: WL
authors.lastname: Devillé
mesh_terms: D018864:Cultural Diversity; D017144:Focus Groups; D006801:Humans; D009426:Netherlands; D009721:Nurse Midwives / Q000523:psychology*; D009723:Nurse-Patient Relations; D011320:Primary Health Care; D000078329:Workforce
keywords: Experiences; Midwives; Non-western women; Qualitative methods