The current standard prenatal care schedule of primary care midwives comprises an average of 14 face-to-face visits. In daily practice, some pregnant women have up to 25 face-to-face visits.
In some midwifery practices, there seems to be an increasing trend of frequent attendance. The prevalence and determinants of inadequate prenatal health care use have been studied at length. However, there has been little research on the prevalence, determinants, and underlying causes of frequent attendance in prenatal care. Poorer outcomes are reported among frequent attenders compared to women with an average of number of visits, e.g. preterm birth and low birth-weight.
Mixed methods, such as a case-control study, a cohort study, interviews and document study, will be used to answer the research questions.
The aim of this study is to examine the prevalence of, the factors associated with and the underlying causes of frequent attendance in primary midwifery care.
- Among low risk women in primary care, what is the prevalence and what of the following factors are associated to women receiving more prenatal visits than recommended by the KNOV-standard compared to those receiving the recommended visits?
- What is the effect of frequent attendance on perinatal outcomes compared with the recommended number of prenatal visits?
- What is the effect of pregnancy related anxiety on the number of prenatal visits compared with no pregnancy related anxiety?
- Are women in primary midwifery care who have midwives’ written comments in their medical files more likely to be frequent attenders compared with women without any memo’s in their medical files?
- How do low-risk women in primary midwifery care, who were frequent attenders during their pregnancy, experience and perceive prenatal health care?
- What are the experiences of midwives and obstetricians concerning frequent attenders in prenatal care compared to women receiving the recommended number of prenatal visits?
- What determinants are related to frequent attendance in obstetric care, and what are the differences and similarities with outcomes in primary care?
In some Dutch midwifery practices, there seems to be an increasing trend of frequent attendance in prenatal care. The problem of frequent attendance is threefold. First, an increasing number of women seem to be having more prenatal visits than outlined in the KNOV recommendations. Second, despite the increase in quantity of care, the outcomes for women and babies is less good among this sub-group of women. Third, increased visits increases the workload of midwives and their clinics without apparent improvement of outcomes. Therefore, it is important to understand why women are receiving more than the anticipated number of prenatal visits in order to determine how to more effective meet their needs and potentially improve the outcomes in this sub-group.