Models of Risk Selection in Maternal and Newborn Care: Exploring the Organization of Tasks and Responsibilities of Primary Care Midwives and Obstetricians in Risk Selection across The Netherlands.

An effective system of risk selection is a global necessity to ensure women and children receive appropriate care at the right time and at the right place. To gain more insight into the existing models of risk selection (MRS), we explored the distribution of different MRS across regions in The Netherlands, and examined the relation between MRS and primary care midwives' and obstetricians' satisfaction with different MRS. We conducted a nationwide survey amongst all primary midwifery care practices and obstetrics departments. The questionnaire was completed by 312 (55%) primary midwifery care practices and 53 (72%) obstetrics departments. We identified three MRS, which were distributed differently across regions: (1) primary care midwives assess risk and initiate a consultation or transfer of care without discussing this first with the obstetrician, (2) primary care midwives assess risk and make decisions about consultation or transfer of care collaboratively with obstetricians, and (3) models with other characteristics. Across these MRS, variations exist in several aspects, including the routine involvement of the obstetrician in the care of healthy pregnant women. We found no significant difference between MRS and professionals' level of satisfaction. An evidence- and value-based approach is recommended in the pursuit of the optimal organization of risk selection. This requires further research into associations between MRS and maternal and perinatal outcomes, professional payment methods, resource allocation, and the experiences of women and care professionals.