title: Student midwives' perceptions on the organisation of maternity care and alternative maternity care models in the Netherlands - a qualitative study.
abstract: A major change in the organisation of maternity care in the Netherlands is under consideration, going from an echelon system where midwives provide primary care in the community and refer to obstetricians for secondary and tertiary care, to a more integrated maternity care system involving midwives and obstetricians at all care levels. Student midwives are the future maternity care providers and they may be entering into a changing maternity care system, so inclusion of their views in the discussion is relevant. This study aimed to explore student midwives' perceptions on the current organisation of maternity care and alternative maternity care models, including integrated care.
  
  
  
  This qualitative study was based on the interpretivist/constructivist paradigm, using a grounded theory design. Interviews and focus groups with 18 female final year student midwives of the Midwifery Academy Amsterdam Groningen (AVAG) were held on the basis of a topic list, then later transcribed, coded and analysed.
  
  
  
  Students felt that inevitably there will be a change in the organisation of maternity care, and they were open to change. Participants indicated that good collaboration between professions, including a shared system of maternity notes and guidelines, and mutual trust and respect were important aspects of any alternative model. The students indicated that client-centered care and the safeguarding of the physiological, normalcy approach to pregnancy and birth should be maintained in any alternative model. Students expressed worries that the role of midwives in intrapartum care could become redundant, and thus they are motivated to take on new roles and competencies, so they can ensure their own role in intrapartum care.
  
  
  
  Final year student midwives recognise that change in the organisation of maternity care is inevitable and have an open attitude towards changes if they include good collaboration, client-centred care and safeguards for normal physiological birth. The graduating midwives are motivated to undertake an expanded intrapartum skill set. It can be important to involve students' views in the discussion, because they are the future maternity care providers.
authors.affiliation: Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands. catja.warmelink@inholland.nl.|Midwifery Academy Amsterdam Groningen, Amsterdam/Groningen, The Netherlands. catja.warmelink@inholland.nl.
authors.forename: J Catja
authors.initials: JC
authors.lastname: Warmelink
authors.affiliation: Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.|Midwifery Academy Amsterdam Groningen, Amsterdam/Groningen, The Netherlands.|The Bamford Centre for Mental Health and Wellbeing, University of Ulster, Coleraine, UK.
authors.forename: T Paul
authors.initials: TP
authors.lastname: de Cock
authors.affiliation: Midwifery Academy Amsterdam Groningen, Amsterdam/Groningen, The Netherlands.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Combee
authors.affiliation: Midwifery Academy Amsterdam Groningen, Amsterdam/Groningen, The Netherlands.
authors.forename: Marloes
authors.initials: M
authors.lastname: Rongen
authors.affiliation: Netherlands institute for health services research (NIVEL), Utrecht, The Netherlands.
authors.forename: Therese A
authors.initials: TA
authors.lastname: Wiegers
authors.affiliation: Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.|Faculty of Health Sciences, McMaster University, Hamilton, Canada.
authors.forename: Eileen K
authors.initials: EK
authors.lastname: Hutton
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D017144:Focus Groups; D066296:Grounded Theory; D006801:Humans; D000070516:Intersectoral Collaboration; D008427:Maternal Health Services / Q000458:organization & administration*; D008880:Midwifery / Q000193:education*; D009426:Netherlands; D011247:Pregnancy; D036301:Qualitative Research; D013336:Students, Health Occupations / Q000523:psychology*
keywords: Integrated care; Maternity care; Midwifery; Primary care; Qualitative research