On the use and determinants of prenatal healthcare services

Esthelle Idberga de Jong

On the use and determinants of prenatal healthcare services

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Het gebruik van prenatale zorg is een belangrijke determinant van de gezondheid van moeder en kind. Dit proefschrift gaat over twee soorten zorggebruik, te weten gebruik van zorg aangeboden binnen prenatale zorgschema’s en aanvullend gebruik van zorg in de zwangerschap. Het prenatale zorgschema bestaat uit de zorg op basis van richtlijnen die zijn bepaald door professionals en betreft veelal preventie. Aanvullende zorg is zorg die zwangeren gebruiken naast de controles aanbevolen in het prenatale zorgschema.
We concludeerden dat een relatief groot deel van de vrouwen die onder zorg zijn van de eerstelijns verloskundige niet voldoen aan de standaard betreffende het prenatale zorgschema. Dit betekent dat deze vrouwen later dan 12 weken in zorg komen en/of een ontoereikend aantal consulten heeft in het vervolg van de zwangerschap. Niet-Westerse vrouwen, werkloze vrouwen, vrouwen met chronische ziekten/handicaps en vrouwen die geen foliumzuur slikten gebruiken significant vaker ontoereikende prenatale zorg.
Het gebruik van aanvullende zorg door zwangere vrouwen was relatief hoog. De huisarts wordt gemiddeld 3,6 keer geconsulteerd; ook maakte bijna 10% van de zwangere vrouwen gebruik van alternatieve zorg.
De uitkomsten zoals beschreven in dit proefschrift over het gebruik van zorg aangeboden
binnen het prenatale zorgschema en het aanvullend gebruik van zorg in de zwangerschap
hebben belangrijke consequenties voor de praktijk, beleid, onderwijs en onderzoek. Dit
proefschrift kan bijdragen tot het verbeteren van de uitkomsten van zorg voor zwangere
vrouwen en hun baby’s.

Originele taal-2	English
Kwalificatie	Doctor of Philosophy
Toekennende instantie	Rijksuniversiteit Groningen
Begeleider(s)/adviseur	Reijneveld, Menno, Supervisor Schellevis, Francois, Supervisor, Externe Persoon Jansen, Danielle, Co-supervisor Baarveld, Frank, Co-supervisor
Datum van toekenning	27-mei-2015
Plaats van publicatie	[Groningen]
Uitgever	University of Groningen
Gedrukte ISBN's	978-90-367-7714-8
Elektronische ISBN's	978-90-367-7715-5
Status	Published - 2015

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Title and contents Final publisher's version, 233 KB
Chapter 1 Final publisher's version, 1,55 MB
Chapter 2 Final publisher's version, 1,55 MB
Chapter 3 Final publisher's version, 1,54 MB
Chapter 4 Final publisher's version, 1,54 MB
Chapter 5 Final publisher's version, 1,44 MB
Chapter 6 Final publisher's version, 1,55 MB
Chapter 7 Final publisher's version, 1,42 MB
Chapter 8 Final publisher's version, 1,25 MB
Appendices Final publisher's version, 1,36 MB
PropositionsFinal publisher's version, 1,04 MB
Complete thesisFinal publisher's version, 3,05 MB
Chapter 9 Final publisher's version, 1,27 MB

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title = "On the use and determinants of prenatal healthcare services",

abstract = "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.",

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AB - 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.

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