Contraceptive care by midwives receives an impressive 9.3, according to recent research among non-postpartum women in the Netherlands. The study, conducted by Merel Sprenger in 2024, reveals positive experiences of women receiving contraceptive care from midwives. Midwives have been allowed to place spirals since 2008 and to offer other forms of contraception since 2015.

In the Netherlands, it is unique that midwives play a broad role in the field of contraception. In most countries, this care is primarily provided by general practitioners or gynaecologists, with exceptions such as Sweden and Estonia. In Sweden, for example, 80% of contraceptive care is provided by midwives. Although 80% of women under the age of 25 in the Netherlands go to GPs for contraceptive care, this study shows that obstetricians can previously be an alternative.

The study, conducted between March and July 2024, was a mixed-methods study with 91 participants from 13 obstetric practices and two ultrasound centres in both urban and rural regions. The study used questionnaires and in-depth interviews, using Levesque's Conceptual Framework of Access to Health model. This model includes five dimensions of accessibility: availability, affordability, appropriateness, approachability, and acceptability.

Most participants were theoretically educated, aged around 28-29 years, and had previously received care from an obstetrician. The inclusion criteria required that the women were at least 16 years old and had not had children in the past six months.

Results showed that non-postpartum women were highly satisfied with the contraceptive care they received from midwives. Factors such as clear communication, sufficient time during appointments and the feeling of comfort were perceived as particularly valuable. Moreover, the personalised approach of midwives and the use of ultrasounds after IUD placement were rated highly. For procedures such as IUD insertion, women felt comfortable, especially having an ultrasound to confirm that the IUD is in place.

Midwives offer not only personal and expert care, but also accessible and affordable services. Appointments can often be scheduled quickly, sometimes in the evenings, and midwives take time for each patient. This makes them an attractive option for women looking for tailored care.

Despite positive experiences, there is still a misconception that midwives focus exclusively on pregnancy care. This perception causes some women to be unaware that they can also turn to a midwife for contraceptive care. Sprenger's study highlights the importance of raising awareness around the broad expertise of midwives. After all, they play a crucial role in providing high-quality and accessible contraceptive care.

This study confirms that midwives play a crucial role in providing high-quality contraceptive care in the Netherlands. Because of their personal approach and expertise, women feel comfortable and can make informed choices. This offers opportunities for a broader division of contraceptive care between GPs and midwives. With more awareness about their role and further training of midwives, they can play an even greater role in improving accessibility to contraceptive care. The study calls for more awareness of contraceptive care options among midwives. Because of their extensive medical knowledge and personal approach, they are well equipped to guide women in making the right choices around contraception.

Sources:

1. Sprenger, M. et al. (2024) Experience of contraceptive care by midwives for nonpostpartum individuals in the Netherlands: A mixed methods study [Preprint]. doi:10.1101/2024.08.01.24311261.
2. Ditzhuijzen Jv, Olofsen S, Knibbeler R, Vlugt Ivd. The first contraception consultation with the GP: satisfaction, expectations, and experiences of young women. Utrecht: Rutgers, 2021
3. Vink MD, Portrait FR, van Wezep T, Koolman X, Mol BW, van der Hijden EJ. Regional variation in health care substitution for intrauterine device insertion: a retrospective cohort study. BMC Prim Care. 2024 Aug 10;25(1):294. doi: 10.1186/s12875-024-02546-7. PMID: 39127618; PMCID: PMC11316978.