As a midwife in the Netherlands for more than twenty years, I have personally experienced how technology in obstetrics has transformed how we deliver care to expectant mothers. With more than 2,000 midwives in the Netherlands, many healthy women – those not typically at risk of complications – choose to receive care directly from a midwife in their own communities. By having access to technologies that have traditionally been found only in the hospital, we are able to provide the best care possible and can monitor for any signs of risk to refer patients to an obstetrician if needed.
The availability of ultrasound for use outside the hospital was a major step forward for us. And now, we are expanding the use of wireless non-stress test (NST) technology, which can provide more parameters to measure the baby’s heart rate and uterine contractions – also known as a cardiotocograph (CTG). This kind of tool has greatly improved the information that midwives can access. Our midwives are now starting to use NST technology in three specific instances for healthy mothers to identify possible risks:
- When a mother is overdue: While the normal amount of time to carry a baby is 40 weeks, the maximum is 42 weeks. After 41 weeks, we perform an NST with ultrasounds to check on the baby’s condition and make sure the situation is not deteriorating. If there are any concerns, then the woman is sent to the hospital and placed under the care of an obstetrician. Otherwise, we continue to test every 3-4 days until her delivery begins naturally.
- When the mother is concerned about the baby’s movements: After 28 weeks of pregnancy, mothers should feel their babies moving at least 10 times a day. Oftentimes, if there is something wrong during a pregnancy, one of the first indications is changing movement patterns of the baby. If the baby starts moving less often or mothers don’t feel movement around the 28-week mark, we conduct NSTs in tandem with ultrasounds to check on the baby’s condition.
- If the baby is in a breech position: If possible, the midwife actively tries to change the baby’s position so that the she can have a normal delivery. After making this attempt, we perform an NST to ensure the baby is comfortable and happy. If unsuccessful and the baby is still in a breech position by 37 weeks, the mother is sent to the hospital and put under the care of an obstetrician.
While mothers who have high-risk pregnancies need additional attention and support, it is our mission as midwives to make sure that all of our patients have healthy, safe deliveries. The opportunity to leverage technology to ensure that we’re partnering with obstetricians in an effective manner to protect our patients can ultimately transform care and make expectant mothers feel more comfortable and confident. Innovative technologies such as wireless maternal/fetal monitoring systems make this possible. Of course we have strong guidelines to implement this new technology, because providing the best care possible is always our main goal.
Siegrid Hoekstra is working as a midwife at Donna, Practice for Obstetrics based in the Netherlands for over twenty years. In her free time, Siegrid enjoys walking, yoga, reading and sailing.