First and second line obstetrics

Obstetricians work in both first and second line care. A client can independently contact an obstetrician in first line care, thus without a referral.

First and second line care
In Dutch healthcare, a distinction is made between first and second line care. First line care is easily accessible care close to home. A client or patient can independently contact care providers in first line care, without a referral. This applies to e.g. a general practitioner, the dentist and the first line obstetrician. They act as gatekeepers to second line care: the more specialist and more expensive care in hospital. Obstetricians work in both first and second line care.

Obstetricians in first line care
A first line obstetrician guides pregnant women as long as progress is normal. She has her own practice or is employed by a practice. If it appears that the pregnancy or delivery is progressing other than normal, the obstetrician makes an assessment of the nature and seriousness of the complications. This is called risk selection. She examines whether specialist care is required and, if so, refers the woman to the hospital.

Obstetricians in second line care
Obstetricians working in hospital are called clinical obstetricians. They work in the delivery room, the outpatient clinic or the maternity ward. Here they guide pregnancies and deliveries that pose an increased risk. They work independently under the responsibility or in consultation with the gynaecologist.

Obstetricians in third line care
Obstetrics also features third line care: this is the highly specialist care offered in academic hospitals, such as specialist echograms and care for very premature births or pregnant women with an increased risk indication.