Rotterdam, the Netherlands

Irma van der Velden

Master course

Physician Assistant for Clinical Midwifery

The staff

Irma v.d. Velden

Medical Biologist

Evelien Cellissen

MPA midwifery

Eveline Wouters MD,PhD

Nicole Steemers MD

Gynaecologist

Rudy Riijke

MD,PhD

Menno Kiel

MD Yvonne Post MPA Midwifery

Els Grijseels

MD,PhD

Bernice Engeltjes

MPA Midwifery

the Netherlands:

some facts and figures

320 km

180 km

41,160 sq km

16,7 million inhabitants

Groningen

Amsterdam

Utrecht

Leiden

Rotterdam

Nijmegen

Maastricht

Average inhabitants per sq km in the Netherlands: 491

Highest population density per sq km: The Hague 5967 inhabitants

Last decades a decreasing number:

1989: 38 %

2009: 24 %

Number of home deliveries in the Netherlands traditionally high (compared to other W-European countries)

increased request for pain relief during labour

a relatively high perinatal mortality (compared to other European countries)

women get older before they get their first born, more risk

more chronicle diseases, more obese

Factors that contribute to this decrease

Number of midwives:

2500 (yr 2010)

750 clinical midwives

47 male

Annual number of baby deliveries: 184,000 (yr 2010)

low risk

midwife

home

delivery

high risk

obstetrician

hospital

delivery

Perinatal care in the Netherlands:

basic principle

Outlines of a Community Midwife

Takes care of patients with low-risk pregnancies and in many cases the

patient will deliver at home

Works autonomously, but abide by the rules of a national midwifery referral

manual

With help of this manual, a risk analysis can be made

Patients can be referred to an obstetrician during pregnancy and/or labour,

if there is any reason to suspect an increased obstetric or medical risk.

What happend the last 10 years:

Midwifes started to play a more important role in the obstetric departments of the hospital.

In many hospitals the community midwives started to run the labour ward under supervision of the obstetrician.

Due to the growing responsibilities:

The need:

1. Properly qualify the midwives for the function they were fulfilling

2. Give them the opportunity to expand their tasks.

The Master Physician Assistant Programme for Clinical Midwives was developed for them.

And introduced in 2005 in Rotterdam.

*Amsterdam MSc

Community midwife ~ Clinical midwife

Master courses*:

The Rotterdam MPA - KV

Four years Bachelor’s degree

Clinical

Midwife

Community

Midwife

2½ years ~ 150 ECTS*

The study is divided into:

first year (60 ECTS),

second year (60 ECTS)

third year (30 ECTS),

All years: including on-the-job training

* (ECTS= credit points,according to the European Credit Transfer System).

Characteristics of the programme

Duration:

Master Physician Assistant Midwifery

(MPA - Midwifery)

Characteristics of the programme

Title:

A Bachelor’s degree in Midwifery

Legal qualification in midwifery (according to the Dutch Individual Health

Care Professions Act) = Dutch BIG Act

Two years of relevant practical experience

A paid position for 32 hours per week

An obstetrician acts as a personal study counsellor / teacher on-the-job

Characteristics of the programme

Access requirements:

An expert in obstetric health care

An obstetrician/ gynaecologist

A rollmodel for the students

A supervisor on the job who evaluates the practical competencies

Characteristics of the programme

The personal study counsellor / teacher on-the-job:

School:

One day in the week to school

Follow 17 theoretical and practical

courses

Including a research programme and a

integrative masterthesis

Clinic:

Work at 3 or 4 days

Based on a task book

Being assessed by the trainer on the job

Characteristics of the programme

Structure:

Expert

Manager

Caregiver

Medical counselor

Teacher

Researcher

Professional

Characteristics of the programme

The Rotterdam Master Advanced Midwifery Practice

Program defines 7 professional roles:

Roles Professional domain Competencies

Expert

Clinical midwifery expert 1. Safeguardance and promotion

of physiology

2. Risk evaluation

Manager Coordination and management

of the health care proces

1. Coördination

2. Triage

Caregiver Support of the healthcare

process

1. Optimal communication

2. Provision of psychosocial care

Medical

counselor

Medical care 1. Diagnostic evaluation

2. Treatment

Teacher Expertise 1. Promotion of expertise

Researcher Practical research 1. Evidence based practice

2. Medical research

Professional Clinical midwife 1. Professionalisation

2. Quality control

o Learning skills

o Safeguarding physiology

o Clinical decision making

o Pathology

o Physical examination

o Triage

o Counseling

o Quality control o Psychosocial problems

o Teaching skills

o Ultrasonography

o Research skills

o Evidence based practice

o Literature review

o Master thesis

o Management skills

o Managing obstetric medical emergencies

Characteristics of the programme

17 training courses:

pe

rce

nta

ge

va

n d

e n

orm

ale

be

va

llin

gen

jaar

57%

Bewerking van: de Neef T, Franx A. Ned Tijdschr Obstet Gynaecol 2009;122:270.

Gegevens van de Stichting Perinatale Registratie Nederland, bewerkt met LVRinsight.

Result: the role of Clinical Midwives rises

Main conclusions, based on assessments Students:

undergo an important development, resulting in functioning at a master level

are more capable in dealing with complex clinical situations

take more initiative

show leadership qualities

are creative and innovative in multidisciplinary teams

Some opinions of medical specialists in the

obstetric units of the hospitals

“They work on a higher level in our department, function more independent,

show more initiative, show more overview in complex situations”

“They have more practical knowledge and skills in clinic (pathology,

gynecology, evidence-based practice)”

“They are more competent in discussions with physicians, and take

responsibility for the team”

First point of contact for the obstetric department

Making diagnoses and prescribe therapy

Responsible for writing and evaluation of protocols in the delivery rooms

Establish skill and drill in emergency training at the department

Providing perinatal audits and education

Conducting scientific research

First shelter for the home deliveries by suspecting an increased obstetric or

medical risk

New tasks:

Dutch tradition at the birth of a baby

Bisquit with anise sprinkles !

Rotterdam, the Netherlands

Thank you!