178 Chapter 8 Effect of regional collaboration on evidence based care (cause 1 and 3) As regional protocols are developed within the interdisciplinary collaboration of an MCN, protocols are influenced by this collaboration (11,13,16,17). Collaboration in MCNs is known to be challenging, because maternity care professionals with different expertise and paradigms need to align (11). Differences in professional paradigms were also reflected in our study exploring the birth beliefs of different disciplines of maternity care professionals. Beliefs about the nature of birth are part of the attitudes of healthcare professionals that influence clinical decision-making. In the development of a regional protocol, these differences in attitudes between disciplines play a role, requiring a collaborative approach based on equality to ensure the creation of a regional protocol that is acceptable to all disciplines. It is therefore essential that professionals have the skills to engage in constructive dialogue and debate in a multidisciplinary setting (18–20). There are different views on the influence of individual care professionals on the culture of shared work environments, such as MCNs (14,16,21). Some researchers have argued that professionals prefer a certain approach in their work based on their education and professional socialisation, resulting in (self)selection of professionals in shared work environments. This means that professionals with the same training or same preferences will collaborate together (21). Other researchers have argued that the circumstances in which professionals work have a profound influence on their approach to their work. They stated that healthcare professionals cannot make their decisions autonomously, because they are influenced by collegial norms (22). According to Dutch maternity care, community midwives are autonomous working healthcare professionals, capable to make autonomous decisions together with the women about childbirth interventions or referral to obstetrician-led care (23). The midwives interviewed for this thesis, mentioned that they are autonomous working professionals providing care within the shared work environment of a midwifery practice and an MCN. Still, some of these midwives mentioned that they adapted their care to avoid criticism from colleagues or because of a feeling of hierarchy towards obstetricians. These midwives seem more sensitive to feelings of hierarchy and the belief that it is correct to follow regional protocols. Reflective practice: insight into midwife’s practices (cause 3) Midwife-led care is indicated by the World Health Organization as the most appropriate care for women with uncomplicated pregnancies, making the midwife the most suitable professional to be the lead carer for these women (24–26). Care by midwives shows a reduction in interventions rates and an improvement in women’s satisfaction with the care they received (26). In the Netherlands, midwives appoint that they ‘guard physiology’, meaning that they prevent unnecessary interventions and provide care that stimulates a physiological process (27). However, current trends of medicalisation in Dutch
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