ORGANISATION OF FOLLOW-UP AND REFERRAL OF PREGNANCY WOMEN IN PRIMARY CARE: PERCEPTION OF GYNAECOLOGISTS AND MIDWIVES

Problem statement

In Belgium the law allows for midwife-led follow-up in case of low-risk pregnancies, but there is no guideline for midwives on when to refer to a specialist in obstetrics and gynecology. We were commissioned to develop a Belgian tool to guide primary care practitioners in specialist’s referral (risk selection). As a preliminary investigation, we surveyed gynecologists and midwives’ views on the current organization of care and their willingness to adopt such tool in their practice .

Methodology

We created an online survey to investigate the role of midwives in antenatal care, their satisfaction with professional collaboration, the extent of their professional networks, their risk assessment and follow-up practices in low-risk pregnancies and, their willingness to use a Belgian risk selection tool. We distributed the survey through professional associations. We analyzed the results using absolute numbers and percentages, stratified by type of health professional (midwife-gynecologist).

Results

Of the 854 respondents, 35.9% were midwives and 64.1% were gynecologists. Among respondents 87.26% of gynaecologists judged interprofessional collaboration with midwives to be satisfactory, versus 67.5% of midwives. Among gynecologists 72.2% considered their professional network to be complete versus 37.5% of midwives. Risk selection in pregnancy was mainly based on the professional’s experience (81.63% of gynecologists and 77.29% of midwives), but 37.1% of gynecologists and 54.8% of midwives rely (also) on risk selection tools coming from abroad or developed in-house. Midwife-led follow-up was recommended by 12.67% of gynecologists and 49.61% of midwives. Among midwives 91.39% were in favor of introducing a Belgian tool versus 36.56% of gynecologists , but 99.56% of midwives and 65.85% of gynecologists would use it if it was implemented .

Conclusions

Among our respondents, midwives had a poorer interprofessional network than gynecologists and, were more likely to suggest midwife-led follow-up, half of them already used existing risk selection tools. Midwives were in favour of the development of a Belgian tool. In contrast, only a minority of gynecologists were in favor of developing a tool, but the majority would use it if it was available.