100 4 CHAPTER 4 2022, 19, 1046 8 of 15 all booking appointments conducted in primary midwifery care practices were discussed multidisciplinary. In four MCCs, the scheduled discussions between primary care midwives and obstetricians and the multidisciplinary discussions were combined. Eighty-one percent of the multidisciplinary discussions took place face-to-face in the hospital and 47% by phone (Table S1). All MCCs reported that decisions were made after discussion. 3.3. Models of Risk Selection Based on variations in the organization of tasks and responsibilities (Tables 2–4), we identified three MRS. In all models, primary care midwives were responsible for the booking appointment of women with uncomplicated pregnancies. The models differed in the organization of tasks and responsibilities for risk assessment after the booking appointment about consultation or transfer of care. Table 5 shows the prevalence of the models of care by region. Table 5. Models of risk selection specified for region (n,%). MRS * 1 MRS 2 MRS 3 n(Row %) n(Row %) n(Row %) Total 42 (61) 16 (23) 11 (16) North 3 (33) 1 (11) 5 (56) East 9 (64) 4 (29) 1 (7) South 2 (14) 10 (71) 2 (14) Southwest 12 (75) 1 (6) 3 (19) Northwest 16 (100) 0 (0) 0 (0) * MRS = Model of risk selection. Model 1: Primary care midwives assessed the risk and initiated a consultation or transfer of care after the booking appointment only if necessary, without discussing this first with the obstetrician. This model resembled the usual MRS and was used in 61% (42) MCCs, which were mainly located in the northwest of The Netherlands. Model 2: Risk was assessed collaboratively after discussion between the primary care midwives and obstetricians. This model was used by 23% (16) of MCCs, which were mainly located in the south of The Netherlands. In 20% (14) of the MCCs, primary care midwives and obstetricians discussed all women who had had a booking appointment with the primary care midwife and whether consultation or transfer of care was indicated. In 2% (three) of the MCCs, women who had their booking appointment in obstetrician-led care were also discussed. Model 3: In 16% (11) of the MCCs, the organization of the tasks and responsibilities regarding risk assessment after the booking appointment within a MCC was unclear or varied amongst the primary midwifery care practices and obstetrics departments that were members of an MCC. This model was predominantly prevalent in the north of The Netherlands. In both model 1 and 2, more than half of the MCCs indicated shared decision-making by primary care midwives and obstetricians. The third model consisted of MCCs where the MRS remained unclear due to contradictory answers amongst respondents within a MCC or variations in the division of tasks and responsibilities within the MCC. 3.4. Change in the Usual Organization of Tasks and Responsibilities in Risk Selection Seventy-two percent (50) of the MCCs made changes in their usual organization of tasks and responsibilities in the risk selection between 2011 and 2019 (Table 6). In 28 (61%) of these MCC, these changes were made between 2014 and 2016. In nine (18%) of these MCCs, the primary care midwives became responsible for all booking appointments, including the booking appointments of women with high-risk profiles. In 21 (42%) of these MCCs, the primary care midwives and obstetricians together started discussing all women who had a booking appointment with a primary care midwife, of which two MCCs also
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