Midwives against Kuipers plan: ‘We lose our independence’

Midwives against Kuipers plan: 'We lose our independence'

Activists from the Emergency Alert Platform for Birth Care have petitioned the House of Representatives. The petition, signed nearly 190,000 times, calls on MPs to block Minister Kuipers’ plan for an integrated rate of birth care.

The main concern for midwives in particular is that they will lose their independence at an integrated rate. Currently, obstetricians and gynecologists and maternity nurses have separate contracts with health insurance companies. As a result, they are now paid separately for the work performed. At an integrated rate, these caregivers will soon have to split one bag of money for each pregnant woman.

In order to do this properly, hospitals, midwifery practices and maternity care must establish so-called integrated birth care organizations (IGOs) at the regional level through which tasks and payments are arranged.


The idea behind this reorganization is that gynecologists and midwives will work better together, which will improve the safety of mother and baby.

But there is much criticism of this intention of the obstetrician. The professional association reports that cooperation between obstetricians and gynecologists has improved significantly over the past twelve years.

Statistics support this statement. In 2008, infant mortality in the Netherlands was still significantly high. This is the reason for taking action from 2010 onwards. Dozens of obstetric partnerships have arisen and the “Standard of Care for Integrated Obstetric Care” has been established.

Within these associations, obstetricians and gynecologists are beginning to work better together. In 2018, the infant mortality rate in the Netherlands was only 10 percent higher than in Finland, according to research by the National Institute of Public Health (RIVM). Finland is a country with traditionally low infant mortality rates.


“In my experience, integrated funding does not improve this collaboration any further,” says Michele Beijerinck, an obstetrician at the Mondo Midwife Clinic in The Hague. She and her practice participated in an experiment to create such an IGO with other obstetric practices and Haga Hospital and tested labor at an integrated rate.

“In those years we’ve particularly noticed that the administrative burden has become heavier. Normally we sent a bill directly to the health insurance company. Now that’s gone through the IGO that represents us all. And that has worked out slower and more bureaucratic.”

However, cooperation in medical content has not become more intense. “Within the IGO, it’s more about finances,” Bejerink says. “So not much has changed in terms of healthcare.”

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