Client-tailored maternity care to increase maternal empowerment: cluster randomized controlled trial protocol; the healthy pregnancy 4 All-2 program

Jacky Lagendijk*, Jasper Been, Hiske Smelt, GJ Bonsel, L.C.M. Bertens, Eric Steegers

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

6 Citations (Scopus)
9 Downloads (Pure)


BackgroundThe postpartum period is an important period for preventive strategies as common maternal and child health risks may become manifest. Women with a lower socioeconomic status tend to have lower maternal empowerment. Increasing their risks of adverse maternal and child health outcomes. This study aims to assess the effectiveness of a primary care level intervention. Delivered to maternity care assistants, aiming to increase maternal empowerment postpartum.MethodsThis study is part of the Dutch nationwide Healthy Pregnancy 4 All-2 (HP4All-2) program, which aims to identify vulnerable mothers and young children at risk of adverse health outcomes, and subsequently improve their care. This program targets women from deprived neighborhoods.A pragmatic cluster randomized controlled trial will be undertaken in 12 maternity care organizations. Maternity care organizations in urban municipalities (i.e. the clusters) will be randomized to either a systematic risk assessment during pregnancy with emphasis on identification of non-medical risk factors for adverse maternal and neonatal health outcomes, and subsequent adaptation of care towards a client-tailored approach during pregnancy and the postpartum period, or solely the systematic risk assessment. The primary outcome is the prevalence of a low maternal empowerment score postpartum. Secondary maternal outcomes cover health-related quality of life, postnatal depression, smoking, alcohol consumption, illicit drug use. Finally, maternal and neonatal health care utilization postpartum are recorded. All outcomes will be analyzed according to the intention-to-treat principle, using multi-level mixed effects models.DiscussionThe study will contribute to evidence regarding the effectiveness of client-tailored, risk-based maternity care to increase maternal empowerment postpartum.Trial registrationNetherlands Trial Registry (NTR) 6311, registered 03-27-2017.
Original languageEnglish
Article number4
Number of pages8
JournalBMC Pregnancy and Childbirth
Publication statusPublished - 3 Jan 2019

Bibliographical note

This study is funded by the Ministry of Health, Welfare and Sports (grant
number: 323911). JVB is funded by personal fellowships from the Erasmus
MC and the Netherlands Lung Foundation (
The study protocol has undergone peer-review by the funding body. The
funding sources had no role in the design of this study and will not have
any role during its execution, analyses, interpretation of the data, or decision
to submit results.

Research programs

  • EMC MGC-02-52-01-A
  • EMC MM-03-54-04-A
  • EMC NIHES-02-65-02


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