Towards integrated antenatal care for low-risk pregnancy
Authors: Benahmed Nadia , Lefevre Mélanie , Christiaens Wendy , Devos Carl , Stordeur Sabine 
Published: January 2025

1. INTRODUCTION 19 -- 2. DESCRIPTION OF THE CURRENT ANTENATAL CARE ORGANISATION IN BELGIUM 21 -- 2.1. HEALTHCARE PROFESSIONALS ENGAGED IN ANTENATAL CARE 21 -- 2.1.1. Gynaecologists - obstetricians 22 -- 2.1.2. Midwives 23 -- 2.1.3. Physiotherapists 25 -- 2.1.4. General practitioners (GPs) 26 -- 2.2. ANTENATAL CARE SETTINGS AND HEALTHCARE INSTITUTIONS ENGAGED IN ANTENATAL -- CARE 29 -- 2.2.1. Hospital settings 29 -- 2.2.2. Private practices 29 -- 2.2.3. Other settings 29 -- 2.2.4. Kind & Gezin, ONE and Kaleido 30 -- 2.2.5. Sickness funds 35 -- 2.3. REGULATORY AND FINANCIAL FRAMEWORK FOR ANC 35 -- 2.3.1. Financial framework 35 -- 2.3.2. Legal framework: liabilities and sanctions 40 -- 2.3.3. Protective measures for (vulnerable) pregnant women 46 -- 2.4. DIGITAL INFORMATION EXCHANGE DURING THE ANTENATAL PERIOD 53 -- 2.4.1. The eHealth initiative 53 -- 2.4.2. Websites and mobile applications (apps) 58 -- 2.5. CONCLUSIONS 58 -- 3. MODELS OF ANTENAL CARE 64 -- 3.1. INTRODUCTION 64 -- 3.2. MIDWIFE-LED CONTINUITY MODELS COMPARED TO DOCTOR-LED MODELS OF CARE -- DURING PREGNANCY 65 -- 3.2.1. Midwife-led continuity models of care (MLCC) 65 -- 3.2.2. Doctor-led and shared models of care 65 -- 3.2.3. Comparison between models of care 66 -- 3.3. COMPARISON BETWEEN CASELOAD MODEL OF CARE AND TEAM MODEL OF CARE 67 -- 3.3.1. Midwife-led continuity models of care: impact on human resources and organisation of -- care 68 -- 3.3.2. Comparison between midwifery and obstetric units 68 -- 3.4. INDIVIDUAL ANTENATAL CARE (ONE-TO-ONE VISITS) COMPARED TO USE OF A GROUP -- MODEL 69 -- 3.4.1. Traditional individual antenatal care 69 -- 3.4.2. Group antenatal care 69 -- 3.4.3. Comparison between models of care 70 -- 3.4.4. Group antenatal care: acceptability and feasibility issues 71 -- 3.4.5. Innovative experiences based on group antenatal care 71 -- 4. NON-CLINICAL INTERVENTIONS: BIRTH PREPARATION AND PARENTHOOD EDUCATION 74 -- 4.1. INTRODUCTION 74 -- 4.2. METHOD 75 -- 4.3. RESULTS OF THE LITERATURE REVIEW IN PEER-REVIEWED JOURNALS 75 -- 4.3.1. Selection results 75 -- 4.3.2. Search results 77 -- 4.4. RESULTS OF THE LITERATURE REVIEW IN GREY PUBLICATIONS: 82 -- 4.5. DISCUSSION 85 -- 4.6. CONCLUSION 86 -- 5. DESCRIPTION OF THE CONSUMPTION OF ANC 87 -- 5.1. INTRODUCTION 87 -- 5.2. METHODS 88 -- 5.2.1. Selection of pregnancies 88 -- 5.2.2. Selection of low-risk pregnancies 88 -- 5.2.3. Characteristics of pregnant women and maternities 90 -- 5.2.4. Care consumption during the antenatal period 93 -- 5.2.5. Anonymization of data 93 -- 5.2.6. Statistical analyses 93 -- 5.3. RESULTS 94 -- 5.3.1. Description of the sample 94 -- 5.3.2. Clinical follow-up of pregnancy 97 -- 5.3.3. Birth preparation 128 -- 5.4. DISCUSSION 139 -- 5.4.1. Limitations with administrative data 139 -- 5.4.2. Providers of ANC 141 -- 5.4.3. Low and high use of ANC 142 -- 5.5. CONCLUSIONS 143 -- 6. PERSPECTIVES OF NEWBORNS PARENTS 144 -- 6.1. INTRODUCTION 144 -- 6.2. METHODOLOGY 144 -- 6.2.1. Design 144 -- 6.2.2. Sampling and recruitement 144 -- 6.2.3. Data collection tools 146 -- 6.2.4. Data analysis 146 -- 6.3. PARTICIPANTS CHARACTERISTICS 147 -- 6.4. PARENTS PERCEPTIONS OF THE ROLES OF ANTENATAL CARE PROVIDERS 149 -- 6.4.1. Perceptions of the role of antenatal care providers in general 149 -- 6.4.2. Parents perception of the role and services of midwives 153 -- 6.4.3. Parents perception of the role of gynaecologists 155 -- 6.4.4. Parents perception of the role of hospitals 159 -- 6.4.5. Parents perception of the role of GPs 159 -- 6.4.6. Parents perception of the role of physiotherapists 160 -- 6.4.7. Parents perception of the role of psychological support 161 -- 6.5. PARENTS CHOICE OF CARE PROVIDER 161 -- 6.5.1. Choice of type of healthcare professional 162 -- 6.5.2. Choice of a specific healthcare professional 164 -- 6.6. PARENTS PERCEPTIONS OF THE ORGANISATION OF ANTENATAL CARE 165 -- 6.6.1. The duration of a consultation 165 -- 6.6.2. The number of consultations and in advance planning 166 -- 6.7. PARENTS EXPERIENCES WITH PRECONCEPTION CARE 167 -- 6.8. PARENTS EXPERIENCES WITH ANTENATAL CARE 169 -- 6.8.1. The first consultation 169 -- 6.8.2. Midwife consultation in early pregnancy 169 -- 6.8.3. Antenatal diagnostics 170 -- 6.8.4. Birth preparation 172 -- 6.8.5. Preparation of postpartum follow-up 174 -- 6.9. PARENTS PERCEPTIONS OF QUALITY OF CARE 176 -- 6.9.1. Accessibility of care 176 -- 6.9.2. Continuity of care 179 -- 6.9.3. Caregiver-patient communication and information provision during pregnancy 184 -- 6.10. PARENTS ROLE AND INVOLVEMENT IN ANTENATAL CARE 193 -- 6.10.1. Decisions, routines or procedures beyond parents control 193 -- 6.10.2. Unpredictability of childbirth 194 -- 6.10.3. Lack of experience and knowledge 194 -- 6.11. PARENTS DISAPPOINTMENTS AND APPRECIATIONS 196 -- 6.11.1. Too much or too little care 196 -- 6.11.2. Defective material 199 -- 6.11.3. Disappointing healthcare professionals attitudes and reactions 199 -- 6.11.4. Organisational issues 202 -- 6.11.5. Medical interventions 203 -- 6.11.6. Parents appreciations 203 -- 7. PERSPECTIVES OF ANC PROFESSIONALS 206 -- 7.1. INTRODUCTION 206 -- 7.2. METHODS 206 -- 7.2.1. Interviews with ANC professionals 206 -- 7.2.2. Brainstorm session with ANC stakeholders 206 -- 7.2.3. Brainstorm to identify non-clinical interventions 207 -- 7.3. FINDINGS 207 -- 7.3.1. Interviews with ANC professionals 207 -- 7.3.2. Brainstorm session with ANC stakeholders 219 -- 7.3.3. Brainstorm session to identify non-clinical interventions 226 -- 7.4. CONCLUSIONS 230 -- 8. ANTENATAL CARE PATHWAYS IN OTHER COUNTRIES 231 -- 8.1. THE NETHERLANDS 231 -- 8.1.1. The Dutch maternity care system 231 -- 8.1.2. Facts and figures 237 -- 8.1.3. Standard for Integrated Birth Care 238 -- 8.2. THE UNITED KINGDOM 248 -- 8.2.1. Principles of antenatal care 248 -- 8.2.2. Levels of care 248 -- 8.2.3. Pathway for antenatal care 248 -- 8.3. FRANCE 255 -- 8.3.1. Monitoring and referral of pregnant women according to identified risk situations: recommendations from HAS 255 -- 8.3.2. Which situations are at risk? 255 -- 8.3.3. Preparing for birth and parenthood: recommendations from Haute Autorité de Santé 263 -- 8.4. IRELAND 264 -- 8.4.1. Current situation: maternity service provision 264 -- 8.4.2. Set-up of a National Maternity Strategy 265 -- 8.5. SWEDEN 269 -- 8.5.1. The Swedish Health system 269 -- 8.5.2. Accessibility and equality 269 -- 8.5.3. Structure of antenatal care 270 -- 8.5.4. Roles and responsibilities of midwives 270 -- 8.5.5. Childbirth and parent education classes 271 -- 8.5.6. Midwifery education 271 -- 8.5.7. Figures and challenges 271 -- 8.6. FINLAND 272 -- 8.6.1. Structure of antenatal care 272 -- 8.6.2. Accessibility and equity 273 -- 8.6.3. Roles and responsibilities of midwives 273 -- 8.6.4. Facts and figures 274 -- 8.7. CONCLUSIONS: COMMON CHARACTERISTICS OF ANC BETWEEN COUNTRIES 274