On the use and determinants of prenatal healthcare services

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    This thesis assessed the prenatal health care use of pregnant women receiving primary midwifery care and on its determinants. Two perspectives were studied, namely the use of care offered within prenatal care programmes and ancillary care use. Prenatal care programmes are based on professional guidelines and mostly concern prevention. Ancillary care is care provided alongside care from maternal healthcare providers (in this thesis the main maternal healthcare provider is a primary care midwife). The research was embedded in the Dutch system of pregnancy care in which midwives have a very important role.
    We found that a relatively high percentage of pregnant women do not fully use the amount and contents of prenatal care offered as part of prenatal care programmes. This inadequate prenatal healthcare use is more likely in some groups of low-risk pregnant women: women of non-Western origin (compared to native-born Dutch women), unemployed women, women reporting chronic illnesses or handicaps, and women who also do not use folic acid periconceptionally were more likely to use prenatal care inadequately.
    In addition to midwifery care, low-risk pregnant women in the Netherlands use a considerable amount of ancillary care. They also visit their GP frequently (on average 3.6 times during their pregnancy, compared to 2.2 times for non-pregnant peers), and 10% of them consult a Complementary and Alternative Medicine practitioner.
    These findings show a need to reconsider either the contents or the implementation of Dutch guidelines for prenatal care in low-risk women, and for optimization of the communication between the professionals who provide care to low-risk pregnant women in the Netherlands.
    Original languageEnglish
    QualificationDoctor of Philosophy
    Awarding Institution
    • University of Groningen
    • Reijneveld, Menno, Supervisor
    • Schellevis, Francois, Supervisor, External person
    • Jansen, Danielle, Co-supervisor
    • Baarveld, Frank, Co-supervisor
    Award date27-May-2015
    Place of Publication[Groningen]
    Print ISBNs978-90-367-7714-8
    Electronic ISBNs978-90-367-7715-5
    Publication statusPublished - 2015

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