Making Evidence Available for Hospital-Based Midwives: A Systematic Examination of the Content and Methodological Quality of Three Protocols Used in Maternity Hospitals in the Netherlands

BACKGROUND: In recent years, the Dutch have begun to question the safety and efficacy of their maternity care system. Particular concerns have been raised about the quality of care in hospital settings. One way to address concerns regarding quality and efficacy of care is by the introduction and use of evidence-based protocols for practice. The primary aims of this study are to (a) describe the availability and diffusion of protocols in Dutch maternity hospitals, (b) systematically assess the methodological quality of these protocols, and (c) consider the content of the protocols in relation to the best evidence for practice.METHODS: A mailed and Internet questionnaire to all hospitals with maternity facilities in the Netherlands inquiring about the availability, content, and methodological quality of protocols for three situations: hypertensive conditions of pregnancy, fetal surveillance, and postpartum hemorrhage. All protocols were systematically assessed twice. We first assessed the methodological quality of the protocol using the Appraisal of Guidelines Research and Evaluation (AGREE) framework, and we then evaluated protocol content using a framework we developed for this purpose. Protocols were scored using a Likert-type scale.RESULTS: There were 53% (N = 48) of all maternity hospitals in the Netherlands that responded. The methodological quality of protocols we evaluated was poor. Using the AGREE framework, 70% of fetal surveillance protocols could not be recommended. Only 1 protocol from 1 hospital scored strongly recommend. Confusion regarding the definition of a protocol and what it should contain were common problems. There was a general paucity of evidence in the protocols assessed.DISCUSSION: Protocols may not be widely available in Dutch maternity hospitals. Where they are available, the quality is poor. There is no national strategy for coordination, implementation, and dissemination of evidence-based protocols. Because centralization, uniformity, and interprofessional collaboration are known to improve adherence, it would be prudent for maternity care professions to develop and disseminate protocols based on best evidence.