Changing midwifery professional responsibilities: The provision of care to women and families in vulnerable circumstances and the position, tasks, and responsibilities of clinical midwives in the Dutch health care system

Background
The midwifery profession is continuously developing. These developments include the role of midwives in providing care to pregnant women and families in vulnerable circumstances and the tasks and responsibilities of clinical midwives. Midwives can play an important role in supporting women and their families who face vulnerable circumstances, but they need adequate tools and support. Regarding clinical midwives, their tasks, responsibilities, and position within the Dutch healthcare system remain unclear and lack formal recognition.
This thesis addresses both issues.

The PhD research
The PhD research examined the knowledge, practices, attitudes, and needs of Dutch midwives and obstetricians concerning vulnerability. Also, a blueprint for integrated care for pregnant women and their families living in vulnerable circumstances has been developed. Within a European collaboration, a joint working definition has been developed using a Delphi study.
Furthermore, the type of deliveries that are usually supported by clinical midwives and the tasks and responsibilities of clinical midwives in Dutch hospitals were examined.
This thesis provides insights in the provision of midwifery care for women and families in vulnerable circumstances and the role of clinical midwives.

Recommendations
Integration of both the medical and social context of pregnant women should be part of routine care, and this should be organized in a coherent network involving childbirth care and social care professionals. A knowledge infrastructure, such as a consortium, can ensure continuous attention toward vulnerability and the development of knowledge and tools that support the provision of adequate care targeted to pregnant women living in vulnerable circumstances. A formal recognition of the position of clinical midwives in the Dutch healthcare system (embedded in policy and regulation), the provision of training leading to a Master’s degree (taking previously acquired skills into account), and acceptance of the professional autonomy of clinical midwives are needed to assure the quality of care that they provide. This would enable them to perform their role in guarding normality within the high-risk context of a hospital.