# Implementation of aspirin use during pregnancy in community midwifery-led care in the Netherlands: A pilot survey

## TL;DR

This study explores how community midwives in the Netherlands implement aspirin use during pregnancy and identifies challenges in prescribing.

## Contribution

The study provides insights into midwives' roles and barriers in aspirin implementation, suggesting potential solutions like prescribing authority and better collaboration.

## Key findings

- Most midwives can identify risk factors for utero-placental complications in low-risk pregnancies.
- One-third of midwives face practical issues when prescribing aspirin.
- Suggestions include granting midwives prescribing authority and improving collaboration with specialists.

## Abstract

Aspirin nowadays is widely used in pregnancy, but implementation among gynecologists took nearly four decades. For a complete insight in the implementation of aspirin, community midwives are to be involved. Community midwives do not have authority to prescribe aspirin and have to refer to a general practitioner or consultant obstetrician for a prescription.

The study was an online, national pilot survey about the implementation of aspirin use during pregnancy among independently practicing community midwives consisting of 29 items with five categories: background, advising, prescribing, possible indications, and clinical practice.

Forty-seven community midwives completed the survey between April and May 2021. All respondents had experience on advising aspirin use in pregnancy. History of preterm pre-eclampsia or HELLP syndrome was identified as a risk factor for developing utero-placental complications by 97.9% of the community midwives. Moderate risk factors in women with otherwise low-risk pregnancy were identified by >75% of the participants. Practical issues in prescribing aspirin were experienced by one-third of the respondents. Suggestions were made to obtain authority for community midwives to prescribe aspirin and improve collaboration with consultant obstetricians and general practitioners.

Community midwives seem to be adequate in identifying risk factors for developing utero-placental complications in women with otherwise low-risk pregnancy. Practical issues for prescribing aspirin occur often. Obtaining authority for community midwives to prescribe aspirin after education should be considered and consulting a consultant obstetrician should become more accessible to overcome the practical issues. Further educating community midwives and general practitioners might improve implementation rates and perinatal outcomes.