Advertisement

The state of professionalisation of midwifery in Belgium: A discussion paper

  • Joeri Vermeulen
    Correspondence
    Corresponding author at: Erasmus Brussels University of Applied Sciences and Arts, Knowledge Centre Brussels Integrated Care, Laarbeeklaan 121, 1090 Brussels, Belgium.
    Affiliations
    Department Health Care, Knowledge Centre Brussels Integrated Care, Erasmus Brussels University of Applied Sciences and Arts, Brussels, Belgium

    Faculty of Medicine and Pharmacy, Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
    Search for articles by this author
  • Ans Luyben
    Affiliations
    Centre for Midwifery, Maternal and Perinatal Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK

    Department of Health Services Research, University of Liverpool, Liverpool, UK
    Search for articles by this author
  • Ronald Buyl
    Affiliations
    Faculty of Medicine and Pharmacy, Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
    Search for articles by this author
  • Serena Debonnet
    Affiliations
    Federal Public Service, Health, Food Chain Safety and Environment, Brussels, Belgium

    Clinique Saint-Jean, Brussels, Belgium
    Search for articles by this author
  • Geneviève Castiaux
    Affiliations
    Paramedical Department Sainte-Elisabeth, University College of Namur-Liège-Luxembourg, Namur, Belgium
    Search for articles by this author
  • Anne Niset
    Affiliations
    Federal Public Service, Health, Food Chain Safety and Environment, Brussels, Belgium

    Centre Hospitalier du Bois de l’Abbaye, Seraing, Belgium

    Belgian Midwives Association, Antwerp, Belgium
    Search for articles by this author
  • Joke Muyldermans
    Affiliations
    Department Health Care, Knowledge Centre Brussels Integrated Care, Erasmus Brussels University of Applied Sciences and Arts, Brussels, Belgium

    Midwifery Practice InTeam, Hoeilaart, Belgium

    Flemish Professional Association of Midwives, Antwerp, Belgium

    Care4Education, Boortmeerbeek, Belgium
    Search for articles by this author
  • Valerie Fleming
    Affiliations
    School of Nursing and Allied Health, Liverpool John Moores University, Liverpool, UK
    Search for articles by this author
  • Maaike Fobelets
    Affiliations
    Department Health Care, Knowledge Centre Brussels Integrated Care, Erasmus Brussels University of Applied Sciences and Arts, Brussels, Belgium

    Faculty of Medicine and Pharmacy, Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
    Search for articles by this author
Published:September 25, 2020DOI:https://doi.org/10.1016/j.wombi.2020.09.012

      Abstract

      Aim

      To describe the state of the professionalisation of midwifery in Belgium, and to formulate recommendations for advancing the midwifery profession.

      Methods

      A descriptive overview of maternity care in Belgium and the professionalisation of midwifery through an analysis of relevant policy and academic texts, underpinned by Greenwood’s sociological criteria for a profession: (1) own body of knowledge, (2) recognised authority, (3) broader community sanctions, (4) own code of ethics and (5) professional culture sustained by formal professional associations. From these insights, recommendations for advancing the midwifery profession in Belgium are formulated.

      Findings

      Current strengths of the professionalisation of midwifery in Belgium included unified midwifery education programmes, progress in midwifery research and overarching national documents for guiding midwifery education, practice and regulation. In contrast however challenges, such as the limited recognition of midwives’ roles by its clientele, limitations of midwives’ competencies and autonomy, lacking development of advanced roles in maternity care practice and a lack of unity of the organisation and its members, were also identified. Based on these, recommendations are made to strengthen Belgian midwifery.

      Conclusions

      Recommendations for advancing the midwifery profession in Belgium includes in particular increasing public awareness of midwives’ roles and competencies, implementing the full scope of midwifery practice and monitoring and advancing this practice. Thus, professional autonomy over both midwifery practice and working conditions should be enhanced. United midwifery organisations, together with women’s groups, other maternity care professionals and policy-makers as equal partners are key to bring about changes in the Belgian maternity care landscape.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Women and Birth
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. WHO Health Topics: Midwifery. 2019. https://www.who.int/topics/midwifery/en/.

        • Renfrew M.J.
        • Homer C.
        • Downe S.
        • et al.
        Midwifery: an executive summary for the Lancet’s series.
        Lancet. 2014; 384: 8
        • Sandall J.
        • Soltani H.
        • Gates S.
        • Shennan A.
        • Devane D.
        Midwife-led continuity models versus other models of care for childbearing women.
        Cochrane Database Syst. Rev. 2016; CD004667
      2. The Lancet. The status of nursing and midwifery in the world. 2020. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30821-7/fulltext.

        • Sandall J.
        Place of Birth in Europe.
        2015
        • Zoege M.
        Die Professionalisierung Des Hebammenberufs: Anforderungen an die Ausbildung.
        Hans Huber, Bern2004
        • Hamilton P.M.
        Realities of Contemporary Nursing.
        Addision-Wesley Nursing, New York1996
        • Vermeulen J.
        • Luyben A.
        • O’Connell R.
        • Gillen P.
        • Escuriet R.
        • Fleming V.
        Failure or progress?: The current state of the professionalisation of midwifery in Europe.
        Eur. J. Midwifery. 2019; 3
        • Greenwood E.
        Attributes of a profession.
        Soc. Work. 1957; 2: 45-55
      3. Statbel: België in cijfers. 2019. https://statbel.fgov.be/nl/themas/bevolking/structuur-van-de-bevolking2020).

        • Benahmed N.
        • Devos C.
        • San Miguel L.
        • et al.
        Caring for mothers and newborns after uncomplicated delivery: towards integrated postnatal care.
        Belgian Health Care Knowledge Centre (KCE). 2014; (Retrieved from)
        • Van de Voorde C.
        • Van den Heede K.
        • Beguin C.
        • et al.
        Required Hospital Capacity in 2025 and Criteria for Rationalisation of Complex Cancer Surgery, Radiotherapy and Maternity Services.
        Health Services Research (HSR) Brussels: Belgian Health Care Knowledge Centre (KCE), 2017 (KCE Reports 289 D/2017/10273/45 2017)
        • Lefèvre M.
        • Bouckaert N.
        • Camberlin C.
        • et al.
        Organisation of Maternity Services in Belgium.
        Health Services Research (HSR) Brussels: Belgian Health Care Knowledge Centre (KCE), 2019 (KCE Reports 323 D/2019/10273/68 2020)
        • Benahmed N.
        • Hendrickx E.
        • Adriaenssens J.
        • Stordeur S.
        Planning Van Gezondheidszorgpersoneel En Gegevens Over Vroedvrouwen.
        Health Services Research (HSR) Brussels: Belgian Health Care Knowledge Centre (KCE), 2016 (KCE Reports 278A D/2016/10273/95 2016)
        • Federal Government of Health, 2015
        The Professional and Competency Profile of the Belgian Midwife.
        ([Het beroeps- en competentieprofiel van de Belgische vroedvrouw]. Retrieved from)2015
        • PlanKad Vroedvrouwen 2004-2014
        Cel Planning Van Het Aanbod Van De Gezondheidszorgberoepen, Dienst Gezondheidszorgberoepen En Beroepsuitoefening, Directoraat-generaal Gezondheidszorg.
        FOD Volksgezondheid, Veiligheid van de Voedselketen en Leefmilieu, 2018
        • Benahmed N.
        • Lefèvre M.
        • Vinck I.
        • Stordeur S.
        Alternative Scenarios for the Forecasting of the Midwifery Workforce: Horizon Scanning and Quantification Model.
        Health Services Research (HSR) Brussels: Belgian Health Care Knowledge Centre (KCE), 2019 (KCE Reports 312C 2019)
        • Mead M.
        • Bogaerts A.
        • Reyns M.
        Midwives’ Perception of the Intrapartum Risk of Healthy Nulliparae in Spontaneous Labour.
        Midwifery, The Flanders, Belgium2007: 361-371 (23)
        • Sandall J.
        Every woman needs a midwife, and some women need a doctor too.
        Birth: Issues Perinatal Care. 2012; 39: 323-326
        • European Parliament Council of the European Union
        Amending Directive 2005/36/EC on the Recognition of Professional Qualifications and Regulation (EU) No 1024/2012 on Administrative Cooperation Through the Internal Market Information System (‘the IMI Regulation’).
        Official Journal of the European Union, 2013 (Retrieved from http://eur-lex.europa.eu/legal-content/EN/ALL/?uri=CELEX:32013L0055. 2013)
        • Embo M.
        • Valcke M.
        Workplace learning in midwifery education in Flanders (Belgium).
        Midwifery. 2016; 33: 24-27
        • Van kelst L.
        • Spitz B.
        • Sermeus W.
        • Thomson A.
        Student midwives’ views on maternity care just before their graduation.
        J. Adv. Nurs. 2013; 69: 600-609
        • Goemaes R.
        • Beeckman D.
        • Verhaeghe S.
        • Van Hecke A.
        Sustaining the quality of midwifery practice in Belgium: challenges and opportunities for advanced midwife practitioners.
        Midwifery. 2020; 89102792
        • Emons J.
        • Luiten M.
        Midwifery in Europe: an Inventory in Fifteen EU-member States: Deloitte & Touche.
        2001
        • Devlieger R.
        • Martens E.
        • Goemaes R.
        • Cammu H.
        Perinatale Activiteiten in Vlaanderen 2017.
        Vzw Studiecentrum voor Perinatale Epidemiologie (SPE), 2018
        • Gray M.
        • Kitson-Reynolds E.
        • Cummins A.
        Starting Life As a Midwife. An International Review of Transition from Student to Practitioner.
        Springer, Cham, Switzerland2019
        • Federal Government of Belgium
        Royal Decree Concerning the Practice of the Profession of Midwife.
        Koninklijk Besluit betreffende de uitoefening van het beroep van vroedvrouw, 1991 (1991)
        • Eggermont M.
        The choice of child delivery is a European human right.
        Eur. J. Health Law. 2012; 19: 257-269
      4. International Code of Ethics for Midwives.
        2014
        • Foster I.R.
        • Lasser J.
        Professional Ethics in Midwifery Practice.
        Jones & Bartlett Publishers, 2010
        • Vlaamse Universiteiten en Hogescholen Raad
        De Onderwijsvisitatie Vroedkunde.
        2014
        • Plappert C.
        • Graf J.
        • Simoes E.
        • Schönhardt S.
        • Abele H.
        The academization of midwifery in the context of the amendment of the german midwifery law: current developments and challenges.
        Geburtshilfe. 2019; 79: 854-862
        • Renfrew M.J.
        • McFadden A.
        • Bastos M.H.
        • et al.
        Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care.
        Lancet. 2014; 384: 1129-1145
        • Vermeulen J.
        • Swinnen E.
        • D’haenens F.
        • Buyl R.
        • Beeckman K.
        Women’s preferences and knowledge about the legal competences of midwives in Brussels, Belgium. A descriptive observational study.
        Midwifery. 2016; 40: 177-186
        • Reinharz D.
        • Blais R.
        • Fraser W.D.
        • et al.
        Cost-effectiveness of midwifery services vs. Medical services in Quebec.
        Can. J. Public Health. 2000; 91: I12-I15
        • Christiaens W.
        • Bracke P.
        Place of birth and satisfaction with childbirth in Belgium and the Netherlands.
        Midwifery. 2009; 25: e11-e19
        • Goemaes R.
        • Beeckman D.
        • Goossens J.
        • Shawe J.
        • Verhaeghe S.
        • Van Hecke A.
        Advanced midwifery practice: an evolutionary concept analysis.
        Midwifery. 2016; 42: 29-37
        • Mattison C.A.
        • Lavis J.N.
        • Wilson M.G.
        • Hutton E.K.
        • Dion M.L.
        A critical interpretive synthesis of the roles of midwives in health systems.
        Health Res. Policy Syst. 2020; 18: 1-16
        • Escuriet-Peiró R.
        • Goberna-Tricas J.
        • Pueyo-Sanchez M.J.
        • et al.
        Impact of maternity care policy in Catalonia: a retrospective cross-sectional study of service delivery in public and private hospitals.
        BMC Pregnancy Childbirth. 2015; 15: 1-10
        • Escuriet R.
        • García-Lausin L.
        • Salgado-Poveda I.
        • et al.
        Midwives’ contribution to normal childbirth care: cross-sectional study in public health settings, the MidconBirth Study protocol.
        Eur. J. Midwifery. 2017; 4: 1-5
        • Fleming V.E.
        Autonomous or automatons? An exploration through history of the concept of autonomy in midwifery in Scotland and New Zealand.
        Nurs. Ethics. 1998; 5: 43-51
        • Vermeulen J.
        • Luyben A.
        • Jokinen M.
        • Matintupa E.
        • O’Connell R.
        • Bick D.
        Establishing a Europe-wide foundation for high quality midwifery education: the role of the European Midwives Association (EMA).
        Midwifery. 2018; 64: 128-131
        • Christiaens W.
        • Nieuwenhuijze M.
        • de Vries R.
        Trends in the medicalisation of childbirth in Flanders and the Netherlands.
        Midwifery. 2013; 29: e1-e8