Advanced Midwifery 1: Big Four


Course Objective

Approximately 85% of perinatal mortality in the Netherlands is linked to
birth defects, premature birth, low birth weight and a poor start at
birth (Bonsel et al., 2010). The increasing number of interventions
during pregnancy and childbirth should increase good outcomes and
comfort of women during labor, but there is increasing evidence that
interventions are used more often than necessary. At this point of view,
supportive and preventive interventions that can improve outcomes are
often underexposed. Midwives should critically reflect on the
interventions that are frequently used (e.g. analgesia and augmentation
of labor, CTG monitoring, ultrasound) and should reflect on the quality
of maternity care in relation to these interventions. The focus will be
on the determinants of health and the promotion, monitoring and
optimizing of the physiology (support physiological birth).

Learning Objectives
1. Uses the knowledge of EBM, perinatal audits, clinical reasoning and
various instruments of risk judgment, for the care of obstetric risk
situations and uses this knowledge to contribute (improve/develop) to
healthcare policies.
2. Is able to explain and discuss structures governing the Dutch- and
other international healthcare systems, to be able to apply economic,
policy, organizational and management theories to analyze 'midwifery
care issues', from both societal and stakeholder perspectives.
3. Is able to explain the diagnostic value (reliability and validity) of
various diagnostic tests and is able to advice when to perform these
tests and is able to interpret the test results.
4. Applies knowledge of assessment, screening and clinical reasoning to
complex obstetric situations and case histories involving multifactor
problems, from a medical (somatic, psychological and functional),
socio-cultural, scientific and ethical perspective.
5. Masters scientific theories relating to patient safety and quality
assurance, including the effectiveness, efficiency and safety of several
triage systems and can apply and weigh up this knowledge in concrete
6. Is able to present orally and in writing specialized knowledge,
insights and scientific views underlying a complex midwifery care issue
to professionals in the field of maternity care, with the specific aims
of 1) translating it into evidence-based midwifery care policies,
guidelines and protocols; 2) promoting and monitoring evidence-based
midwifery care; or 3) the implementation of their own regional policies,
advices, guidelines and protocols in midwifery care.

Course Content

In this module, themes are positioned around pregnant women with:
• IUGR (intrauterine growth retardation)
• Preterm birth
• Congenital anomalies
• Suboptimal start of the neonate (different increased risks resulting
in suboptimal neonatal start/low Apgar score)
The topics are offered with complex case histories from specific groups:
• Multiple problems, medical, social, psychological;
• Multiple caregivers involved;
• Medical ethically complex situations;
• Policy, organizational management and economic theories.

Teaching Methods

Lectures on location: on average 7 hours per week.
Lectures (approximately 16 hours, workgroup 48 hours, individual study
104 hours) 6EC = 168 SBU.
Advanced Midwifery Science module is a part-time course of 8 weeks.
Total study time is 168 hours.

Method of Assessment

The final grade is being determined by:
a theoretical Individual open question exam (40%);
scientific paper/written assignment, individual or duo (40 %);
oral presentation(s) (20%).
All exams need to be passed (minimum 5.5)

Entry Requirements

Bachelor Midwifery plus premaster Health Sciences.


Blackburn, S. T. (2013). Maternal, Fetal, & Neonatal Physiology: A
Clinical Perspective (4th ed.).
Maryland Heights, MO: Elsevier Saunders.
ISBN: 9781437716238
A selection of literature will be made on the basis of lectures and
state of the art research.
Bonsel, G.J, Birnie, E, Denktaş, S, Steegers, E.A.P, & Poeran, V.J.J.
(2010). Lijnen in de Perinatale Sterfte. Erasmus MC: University Medical
Center Rotterdam. Retrieved from
Renfrew, M., McFadden, A., Bastos, M., Campbell, J., Channon, A.,
Cheung, N., Eugene Declercq, E. (2014). Midwifery and quality care:
findings from a new evidence-informed framework for maternal and newborn
care. Lancet, 384(9948), 1129-1145
Homer, C., Friberg, I., Bastos Dias, M., ten Hoope-Bender, P., Sandall,
J., Speciale, A., Bartlett, L. (2014). The project effect of scaling up
midwifery. Lancet, 384 (9948), 1146-1157
Van Lerberghe, W., Matthews, Z., Achadi, E., Ancona, C., Campbell, J.,
Channon, A., Turkmani, S. (2014). Country experience with strengthening
of health systems and development of midwives in countries with high
maternal mortality. Lancet, 384 (9948), 1215-1225
Ten Hoope-Bender, P., de Bernis, L., Campbell, J., Downe, S., Fauveau,
V., Fogstad, H., .Van Lerberghe, W. (2014). Improvement of maternal and
newborn health through midwifery. Lancet, 384 (9948), 1226-1235.

Target Audience

Bachelor Midwifery students.

Additional Information

Dr. Caroline Geerts (MD, researcher and lecturer)
Dr. Ank de Jonge (midwife, associated professor)
Dr. Trudy Klomp (midwife, researcher, lecturer and coördinator of the
Dr. Linda Martin (psychologist, lecturer and researcher)
Dr. Corine Verhoeven (midwife PA, researcher, lecturer)
Dr. Anke Witteveen (psychologist, researcher, lecturer)

General Information

Course Code AM_1188
Credits 6 EC
Period P1
Course Level 400
Language of Tuition English
Faculty Faculty of Science
Course Coordinator dr. G.M.T. Klomp MSc
Examiner dr. G.M.T. Klomp MSc
Teaching Staff

Practical Information

You need to register for this course yourself

Last-minute registration is available for this course.

Teaching Methods Study Group, Lecture, Practical
Target audiences

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