title: Improving interprofessional coordination in Dutch midwifery and obstetrics: a qualitative study.
abstract: BACKGROUND
  Coordination between the autonomous professional groups in midwifery and obstetrics is a key debate in the Netherlands. At the same time, it remains unclear what the current coordination challenges are.
  
  
  METHODS
  To examine coordination challenges that might present a barrier to delivering optimal care, we conducted a qualitative field study focusing on midwifery and obstetric professional's perception of coordination and on their routines. We undertook 40 interviews with 13 community midwives, 8 hospital-based midwives and 19 obstetricians (including two resident obstetricians), and conducted non-participatory observations at the worksite of these professional groups.
  
  
  RESULTS
  We identified challenges in terms of fragmented organizational structures, different perspectives on antenatal health and inadequate interprofessional communication. These challenges limited professionals' coordinating capacity and thereby decreased their ability to provide optimal care. We also found that pregnant women needed to compensate for suboptimal coordination between community midwives and secondary caregivers by taking on an active role in facilitating communication between these professionals.
  
  
  CONCLUSIONS
  The communicative role that pregnant women play within coordination processes underlines the urgency to improve coordination. We recommend increasing multidisciplinary meetings and training, revising the financial reimbursement system, implementing a shared maternity notes system and decreasing the expertise gap between providers and clients. In the literature, communication by clients in support of coordination has been largely ignored. We suggest that studies include client communication as part of the coordination process.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Westzeedijk 118, Rotterdam 3016 AH, The Netherlands. vera.schoelmerich@cantab.net.
authors.forename: Vera L N
authors.initials: VL
authors.lastname: Schölmerich
authors.forename: Anke G
authors.initials: AG
authors.lastname: Posthumus
authors.forename: Halleh
authors.initials: H
authors.lastname: Ghorashi
authors.forename: Adja J M
authors.initials: AJ
authors.lastname: Waelput
authors.forename: Peter
authors.initials: P
authors.lastname: Groenewegen
authors.forename: Semiha
authors.initials: S
authors.lastname: Denktaş
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D008880:Midwifery / Q000458:organization & administration*; D009426:Netherlands; D009774:Obstetrics / Q000458:organization & administration*; D011247:Pregnancy; D011361:Professional Competence / Q000592:standards*; D036301:Qualitative Research; D011787:Quality of Health Care; D012189:Retrospective Studies
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