The Experiences of Midwives in Caring for Vulnerable Pregnant Women in The Netherlands: A Qualitative Cross-Sectional Study.

Vulnerable pregnant women have an increased risk for preterm birth and perinatal mortality. This study identifies the perspectives, perceived barriers, and perceived facilitators of midwives toward current care for vulnerable pregnant women in the Netherlands. Knowing those perspectives, barriers, and facilitators could help increase quality of care, thereby reducing the risks of preterm birth and perinatal mortality. Midwives working in primary care practices throughout the Netherlands were interviewed. Semi-structured interviews were conducted remotely through a video conference program, audio recorded, transcribed verbatim, and coded based on the theoretical domains framework and concepts derived from the interviews, using NVivo-12. All midwives provided psychosocial care for vulnerable pregnant women, expected positive consequences for those women resulting from that care, considered it their task to identify and refer vulnerable women, and intended to improve the situation for mother and child. The main barriers perceived by midwives were too many organizations being involved, inadequate communication between care providers, lack of time to care for vulnerable women, insufficient financing to provide adequate care, and uncooperative clients. The main facilitators were having care coordinators, treatment guidelines, vulnerability detection tools, their own knowledge about local psychosocial organizations, good communication skills, cooperative clients, consultation with colleagues, and good communication between care providers. The findings suggest that midwives are highly motivated to care for vulnerable women and perceive a multitude of facilitators. However, they also perceive various barriers for providing optimal care. A national guideline on how to care for vulnerable women, local overviews of involved organizations, and proactive midwives who ensure connections between the psychosocial and medical domain could help to overcome these barriers, and therefore, maximize effectiveness of the care for vulnerable pregnant women.