In the Netherlands, there are three professional groups (midwives, GPs and gynaecologists) who are authorised to independently supervise a woman during her pregnancy, parturition and the postnatal period. Specialist help is only reimbursed by health insurers if there is a medical indication for this. The indication (risk assessment) is in principle determined by the midwife or the GP of the client/patient concerned. How the risk assessment should take place and who should perform this is a controversial point, and one on which the different professional organisations and individual professional practitioners differ in opinion. At the initiative of the Health Care Insurance Board, a committee was set up in 1983, in which representatives from the various professional groups active in obstetrics also took part, with the request to try to reach a consensus about an indication list that would apply to all professional groups. This new indication list was presented in 1987. There was agreement about several basic principles:
- pregnancy, parturition and the postnatal period are, in principle, physiological events
- it is not irresponsible to allow a parturition that is expected to proceed normally to take place at home
- specialised help is therefore only necessary during pregnancy, parturition and the postnatal period if this provides added value over and above that which the GP or midwife can provide in terms of medical care.
Based on the above principles the following starting points were formulated:
- the pregnant woman can be supervised by an obstetric care provider in primary care (midwife or GP) unless there is a medical indication (or a medical indication develops) that requires referral to obstetric care provider (gynaecologist) in secondary care.
- the pregnant woman can give birth at home (or in a hospital as substitute home birth) unless there is an indication or an indication develops that requires parturition in the hospital.
The compilers of the list subsequently formulated four decisive criteria that allow the risk to be reassessed at each check-up. These criteria are:
- what is the nature and severity of the complication(s) for which the risk is elevated?
- what options are available (in primary or secondary care) to prevent the occurrence of the complication(s)?
- what options are available (in primary or secondary care) to detect the occurrence of the complication(s) at an early stage?
- what options are available (in primary or secondary care) to intervene adequately should this/these complication(s) occur?