title: Opinions of maternity care professionals and other stakeholders about integration of maternity care: a qualitative study in the Netherlands.
abstract: This study aims to give insight into the opinions of maternity care professionals and other stakeholders on the integration of midwife-led care and obstetrician-led care and on the facilitating and inhibiting factors for integrating maternity care.
  
  
  
  Qualitative study using interviews and focus groups from November 2012 to February 2013 in the Netherlands. Seventeen purposively selected stakeholder representatives participated in individual semi-structured interviews and 21 in focus groups. One face-to-face focus group included a combined group of midwives, obstetricians and a paediatrician involved in maternity care. Two online focus groups included a group of primary care midwives and a group of clinical midwives respectively. Thematic analysis was performed using Atlas.ti. Two researchers independently coded the interview and focus group transcripts by means of a mind map and themes and relations between them were described.
  
  
  
  Three main themes were identified with regard to integrating maternity care: client-centred care, continuity of care and task shifting between professionals. Opinions differed regarding the optimal maternity care organisation model. Participants considered the current payment structure an inhibiting factor, whereas a new modified payment structure based on the actual amount of work performed was seen as a facilitating factor. Both midwives and obstetricians indicated that they were afraid to loose autonomy.
  
  
  
  An integrated maternity care system may improve client-centred care, provide continuity of care for women during labour and birth and include a shift of responsibilities between health care providers. However, differences of opinion among professionals and other stakeholders with regard to the optimal maternity care organisation model may complicate the implementation of integrated care. Important factors for a successful implementation of integrated maternity care are an appropriate payment structure and maintenance of the autonomy of professionals.
authors.affiliation: Department of Midwifery Science, Midwifery Academy Amsterdam/Groningen (AVAG) and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. h.perdok@vumc.nl.|Catharina Hospital, Eindhoven, The Netherlands. h.perdok@vumc.nl.
authors.forename: Hilde
authors.initials: H
authors.lastname: Perdok
authors.affiliation: Department of Clinical Genetics, Section Community Genetics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.|TNO Quality of Life, Leiden, The Netherlands.
authors.forename: Suze
authors.initials: S
authors.lastname: Jans
authors.affiliation: Department of Midwifery Science, Midwifery Academy Amsterdam/Groningen (AVAG) and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.|Maxima Medical Centre, Veldhoven, The Netherlands.
authors.forename: Corine
authors.initials: C
authors.lastname: Verhoeven
authors.affiliation: Department of Clinical Genetics, Section Community Genetics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Lidewij
authors.initials: L
authors.lastname: Henneman
authors.affiliation: Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors.forename: Therese
authors.initials: T
authors.lastname: Wiegers
authors.affiliation: Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia.
authors.forename: Ben Willem
authors.initials: BW
authors.lastname: Mol
authors.affiliation: Netherlands Institute for Health Services Research, Utrecht, The Netherlands.|Department of General Practice & Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: François
authors.initials: F
authors.lastname: Schellevis
authors.affiliation: Department of Midwifery Science, Midwifery Academy Amsterdam/Groningen (AVAG) and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Ank
authors.initials: A
authors.lastname: de Jonge
mesh_terms: D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care; D003299:Cooperative Behavior; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D008880:Midwifery / Q000191:economics / Q000193:education / Q000458:organization & administration*; D017146:Models, Organizational; D009426:Netherlands; D009774:Obstetrics / Q000191:economics / Q000458:organization & administration*; D010358:Patient Participation; D018802:Patient-Centered Care; D010819:Physician's Role; D011247:Pregnancy; D017009:Professional Autonomy; D036301:Qualitative Research; D060926:Remuneration
keywords: Continuity of care; Integrated care; Maternity care; Midwifery; Obstetrics