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Sub-optimal obstetric care in The Netherlands is partly to be explained by process parameters with regard to adequate management of the Big 3 causes of perinatal mortality (preterm birth before 32 weeks of gestational age, small-for-gestational-age (SGA) and perinatal asphyxia). An important issue is the communication between professionals within one discipline and between disciplines. There is ample evidence that – especially when a pregnant woman has to be referred from Primary to Secondary care – the current way of communication is far from optimal. This may also apply to a patient referral from Secondary Care to Tertiary Care. The inadequate communication and collaboration is partly to be explained by the use of different protocols, partly because the processes that are used are rather divers. Transmural team training, both regarding aspects of acute as well as non-acute obstetric care, will increase communication and collaboration between different levels of obstetric care and contribute to optimal perinatal outcome and patient satisfaction.



Assessment of the most frequent problems encountered in communication between different health professionals within one discipline and between disciplines will supply information about the relevant targets for problem solving. These will be implemented into a training session where the optimal management of Big 3 obstetric causes of poor perinatal outcome will be used as training scenarios for the transmural team training. After three months, in situ (local) simulations will be performed to evaluate transmural cooperation and communication, using a stepped wedge trial design.

The assessment, the training and the simulation program will be developed and tested in a pilot area. This area is characterized by a relative well organized infrastructure: a large teaching hospital (Maxima Medical Centre), also one of the ten perinatal centers of the country, and a large Primary Care midwifery group who refers to this hospital. After a first careful evaluation of the pilot data, the program will be implemented in a larger area: the Consortium Brabant with an adherence of six hospitals and over one million inhabitants.


Prior to the training and in situ simulations, qualitative (in depth interviews) as well quantitative research will be performed in pregnant women / partners, recently delivered women / partners, obstetric care providers. This will result in insight in client and care provider relevant topics concerning adequate communication as well as in the development of instruments to assess quantitative data on patient and care provider satisfaction with regard to communication between health professionals as well as between patient – health professional. The final stage of the research project consists of data analysis and the formation of a study report.



Obstetric workers representing ambulance services and home maternity nurses, the primary care, the secondary care and tertiary care.


Study outcome

Primary outcome: Perinatal outcome in general and with regard to the Big 3 causes of perinatal mortality in particular.

Secondary outcome: team performance and protocol adherence. Satisfaction of the patient and her partner, as well as professional satisfaction.


Time schedule

The study will start at the first of September 2012 and will last for 48 months.

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