Intrapartum Care Working Patterns of Midwives: The Long Road to Models of Care in Germany

Abstract

Introduction Midwifery models of care help to enhance perinatal health outcomes, women's satisfaction, and continuity of care. Despite the ubiquitous presence of certified midwives at births in Germany, no research has investigated the diversity of midwives’ practice patterns. Describing the variety of working patterns through which midwives provide intrapartum care may contribute to improving the organisation of midwifery services.

Methods This cross-sectional survey took place in the region of Hannover and Hildesheim, Germany. Midwives attending births and practicing in hospitals and/or out-of-hospital were able to participate. Midwives who did not attend births were excluded. We assessed midwives' scope of services, practice locations, employment patterns, continuity of care, midwife-led births, and midwives' level of agreement with core values of midwifery care. The response rate of the survey was 32.7 % (69/211).

Results We found that midwifery care services can be described according to midwives’ employment patterns. The majority of midwives were employed in a hospital to provide intrapartum care (74.2 %, n = 49), and most also independently offered one or more antenatal and/or postpartum service/s. Only 25.8 % (n = 17) of midwives offered their services independently (laborist model of care). Independent midwives attended births in all three possible settings: hospital, free-standing birth centres and home. Significantly more independent midwives than employed midwives offered antenatal care and lactation consulting. Compared to employed midwives, significantly more independent midwives provided antenatal, intrapartum, and postpartum care to the same women, were more likely to know women before labour, and to offer one-to-one care during labour.

Discussion The most common practice pattern among surveyed midwives was ‘employment in a hospital’ for provision of intrapartum care with additional postpartum and few antenatal services provided on an independent basis. Midwives who worked solely independently reported more continuity and one-to-one intrapartum care with women. Most midwives did not work in patterns that offered continuity of care or consistently provide one-to-one care. Future research should assess whether women in Germany desire more services similar to caseload midwifery.

Zusammenfassung

Einleitung Hebammenbetreuungsmodelle fördern das peripartale Gesundheitsergebnis, die mütterliche Zufriedenheit sowie die Betreuungskontinuität. Trotz der allgegenwärtigen Präsenz von zertifizierten Hebammen bei Geburten in Deutschland, wurden die vielfältigen Arbeitsstrukturen von Hebammen noch nicht untersucht. Ziel dieser Studie war es, Arbeitsstrukturen von Hebammen zu beschreiben, um einen Beitrag zur Verbesserung der Hebammendienstleistungen aufzuzeigen.

Methoden Die Querschnittserhebung wurde in der Region Hannover und Hildesheim, Niedersachsen, durchgeführt. Hebammen, die Geburten betreuten und in Krankenhäusern und/oder außerhalb von Krankenhäusern tätig waren, konnten teilnehmen. Hebammen, die keine Geburten betreuten, wurden aus der Studie ausgeschlossen. Beurteilt wurden das Leistungsspektrum, der Arbeitsplatz, die Arbeitsbedingungen, die Betreuungskontinuität und die Übereinstimmung von Hebammen mit zentralen Zielen der Hebammentätigkeit. Die Rücklaufquote der Studie lag bei 32,7% (69/211).

Ergebnisse Hebammenbetreuung konnte am ehesten in Verbindung mit den Arbeitsstrukturen beschrieben werden. Der Großteil der Hebammen war im Krankenhaus angestellt und betreute dort Gebärende (74,2 %, n = 49). Darüber hinaus boten die meisten Hebammen selbstständig Leistungen der Schwangerenvorsorge oder des Wochenbetts an. Nur 25,8 % (n = 17) der Hebammen waren alleinig freiberuflich tätig. Freiberufliche Hebammen begleiteten Geburten an allen drei möglichen Geburtsorten: Im Krankenhaus, im Geburtshaus und Zuhause. Im Vergleich zu angestellten Hebammen boten signifikant mehr freiberuflich tätige Hebammen Schwangerenvorsorgen und Stillberatungen an und betreuten ein und dieselben Frauen sowohl vor, während als auch nach der Geburt, kannten die Schwangeren eher vor der Geburt und boten öfter eine Eins-zu-eins- Betreuung während der Geburt an.

Diskussion Unter den befragten Hebammen war das verbreitetste Betreuungsmodell die Anstellung im Krankenhaus zur Betreuung von Geburten im Krankenhaus, mit zusätzlicher freiberuflicher Wochenbettbetreuung. Deutlich seltener wurde Schwangerenvorsorge auf freiberuflicher Basis angeboten. Hebammen, die ausschließlich freiberuflich arbeiteten, berichteten von mehr Kontinuität und einer Eins-zu-eins-Betreuung von Frauen bei der Geburt. Die Mehrheit arbeitete nach einem Modell, das keine Betreuungskontinuität oder eine konsequente Eins-zu-eins-Betreuung bot. Zukünftige Forschung sollte klären, ob sich Frauen in Deutschland mehr fallgebundene Eins-zu-eins-Betreuung von einer Hebamme wünschen.

Key words

models of care - midwifery - Germany - caseload midwifery - midwife led care

Schlüsselwörter

Betreuungsmodelle - Hebammentätigkeit - Deutschland - Hebammengeleitete Betreuung

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