Organization and workload of midwifery care in the Netherlands.
Bibliographic record
Abstract
Introduction: The organization of maternity care in the Netherlands is very different from that in the rest of Europe, with its independent, primary care midwives, its policy of continuous risk-selection, its high proportion of home births, and its professional maternity care assistants. Background: Most primary care midwives in the Netherlands are selfemployed practitioners. They provide maternity care throughout pregnancy, childbirth, and the postpartum period. Women with (an increased risk of) complications will be referred to a gynaecologist/obstetrician. Women at low risk can choose to give birth at home. In the late 1990s the workload of midwives increased strongly, endangering the possibility for women to give birth at home. Therefore, measures were taken to increase the number of practicing midwives, to reduce the workload, and to safeguard the home birth option. The purpose of this research was to provide insight in the changes occurring in the organization and workload of midwifery care following these actions. Methods: In four consecutive years (2001–2004) all midwives in a representative sample of midwifery practices kept a registration/diary of their work during three weeks continuously. They also filled out questionnaires about the practice organization, work schedules, and experiences of workload. Results: The average practice-size of a midwifery practice increased from 3.1 to 3.5 midwives. Midwives work on an average 29 h a week and are on-call for another 35 h. More than a quarter of their time is spent on non-client-related activities. Time spent on direct client care (consultations, check-ups, assistance during birth, postnatal visits) increased by ±20%. Especially the average time spent with a woman during labour and birth increased by almost a third. Conclusions: Although midwives in 2004 work on an average the same number of hours per week as they did in 2001, their workload is reduced, resulting in less clients per midwife and more time per client. (aut. ref.)
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".