102 4 CHAPTER 4 Int. J. Environ. Res. Public Health2022, 19, 1046 10 of 15 Table 7. Level of satisfaction by Maternity Care Collaboration, primary midwifery care practices and obstetrics departments (p). MCC# Primary Midwifery Care Practices Obstetrics Departments Very Satisfied Not Very Satisfied Very Satisfied Not Very Satisfied Very Satisfied Not Very Satisfied n(%) n(%) n(%) n(%) n(%) n(%) Quality of care MRS# 1 32 (57) 10 (77) 34 (61) 7 (63) 17 (47) 13 (81) MRS 2 14 (25) 2 (15) 13 (23) 2 (18) 13 (36) 1 (6) MRS 3 10 (18) 1 (7) 9 (16) 2 (18) 6 (17) 2 (13) Collaboration MRS 1 28 (55) 14 (78) 26 (54) 15 (79) 20 (53) 10 (71) MRS 2 13 (25) 3 (17) 13 (27) 2 (12) 12 (32) 2 (14) MRS 3 10 (20) 1 (6) 9 (19) 2 (12) 6 (16) 2 (14) p-value * 0.23 0.17 0.46 Organization of care MRS 1 20 (56) 22 (67) 22 (63) 19 (59) 15 (54) 15 (63) MRS 2 9 (25) 7 (21) 7 (20) 8 (25) 8 (29) 6 (25) MRS 3 7 (19) 4 (12) 6 (17) 5 (16) 5 (18) 3 (13) p-value * 0.66 0.94 0.80 Time investment MRS 1 12 (67) 30 (59) 9 (64) 32 (60) 14 (64) 16 (53) MRS 2 3 (17) 13 (25) 3 (21) 12 (23) 5 (23) 9 (30) MRS 3 3 (17) 8 (16) 2 (14) 9 (17) 3 (14) 5 (17) p-value * 0.74 1.00 0.74 Autonomy MRS 1 32 (64) 10 (53) 32 (65) 9 (50) 23 (55) 7 (70) MRS 2 11 (22) 5 (26) 11 (22) 4 (22) 11 (26) 3 (30) MRS 3 7 (14) 4 (21) 6 (12) 5 (28) 8 (19) 0 p-value * 0.64 0.29 0.44 * Fisher exact test, statistically significant (p< 0.05). # MCC = Maternity Care Collaboration. # MRS = models of risk selection. 4. Discussion Exploring the organization of tasks and responsibilities of primary care midwives and obstetricians in risk selection in The Netherlands, we identified three MRS. We found that the majority of the MCCs work according to the usual MRS, where primary care midwives assess the risk, and initiate a consultation or transfer of care after the booking appointment only if necessary, without discussing this first with the obstetrician. In the second MRS, after the booking an appointment, primary care midwives assess the risk and make decisions about the consultation or transfer of care collaboratively with obstetricians. The third model consists of models with other characteristics. We did not find significant differences between the MRS and levels of satisfaction. Our survey showed that most MCCs in The Netherlands work according to the usual MRS, where primary care midwives initiate a consultation or transfer of care only if necessary, without discussing this first with an obstetrician, and conform to the agreements laid down in the division of tasks and responsibilities between midwives and obstetricians in the LMI [13–15]. Experiments in the past decade with MRS included a model in which midwives and obstetricians always collaboratively assess risks and make decisions, which is now used by almost a quarter of the MCCs [13–15]. The MRS vary in several aspects, including routinely scheduled discussions, attending professionals at discussions, and 2022, 19, 1046 10 of 15 Table 7. Level of satisfaction by Maternity Care Collabo ati n, p imary midwifery care practi es and obstetrics departments (p). MCC# Primary Midwifery Care Practices Obstetrics Departments Very Satisfied Not Very Satisfied Very Satisfied Not Very Satisfied Very Satisfied Not Very Satisfied n(%) n(%) n(%) n(%) n(%) n(%) MRS# 1 32 (57) 10 (77) 34 (61) 7 (63) 17 (47) 13 (81) MRS 2 14 (25) 2 (15) 13 (23) 2 (18) 13 (36) 1 (6) MRS 3 10 (18) 1 (7) 9 (16) 2 (18) 6 (17) 2 (13) Collaboration MRS 1 28 (55) 14 (78) 26 (54) 15 (79) 20 (53) 10 (71) MRS 2 13 (25) 3 (17) 13 (27) 2 (12) 12 (32) 2 (14) MRS 3 10 (20) 1 (6) 9 (19) 2 (12) 6 (16) 2 (14) p-value * 0.23 0.17 0.46 care MRS 1 20 (56) 22 (67) 22 (63) 19 (59) 15 (54) 15 (63) MRS 2 9 (25) 7 (21) 7 (20) 8 (25) 8 (29) 6 (25) MRS 3 7 (19) 4 (12) 6 (17) 5 (16) 5 (18) 3 (13) p-value * 0.66 0.94 0.80 Time investment MRS 1 12 (67) 30 (59) 9 (64) 32 (60) 14 (64) 16 (53) MRS 2 3 (17) 13 (25) 3 (21) 12 (23) 5 (23) 9 (30) MRS 3 3 (17) 8 (16) 2 (14) 9 (17) 3 (14) 5 (17) p-value * 0.74 1.00 0.74 Autonomy MRS 1 32 (64) 10 (53) 32 (65) 9 (50) 23 (55) 7 (70) MRS 2 11 (22) 5 (26) 11 (22) 4 (22) 11 (26) 3 (30) MRS 3 7 (14) 4 (21) 6 (12) 5 (28) 8 (19) 0 p-value * 0.64 0.29 0.44 * Fisher exact test, stat stically significant (p< 0.05). # MCC = Maternity Care Collabo ation. # MRS = models of risk selection. 4. Discussion Exploring the organization of tasks and responsibilities of primary care midwives and obstetricians in risk selection in The Netherlands, we identified three MRS. We found that the majority of the MCCs work according to the usual MRS, where p ima y care midwives assess the risk, and initiate a consultation or transfer of care after the booking appointment only if necessary, without discussing this first with the obstetrician. In the second MRS, after the booking an appointment, primary care midwives assess the risk and make decisions about th consultation or ransfer of care collaboratively with obstetricians. The third model consists of models with other characteristics. We did not find significa t differences between the MRS and levels of satisfaction. Our survey showed that most MCCs in The Netherlands work according to the usual MRS, where primary care midwives initiate a consultation or transfer of care only if necessary, without discussing this first with an obstetrician, and conform to the agreements laid down in the division of tasks and responsibilities between midwives and obstetricians in the LMI [13–15]. Experiments in the past decade with MRS included a model in which midwives and obstetricians always collaboratively assess risks and make decisions, which is now used by almost a quarter of the MCCs [13–15]. The MRS vary in several aspects, including routinely scheduled discussions, attending professionals at discussions, and Table 7. Level of satisfaction by Maternity Care Collaboration, primary midwifery care practices and obstetrics departments (p). MCC# Primary Midwifery Care Practices Obstetrics Departments Very Satisfied Not Very Satisfied Very Satisfied Not Very Satisfied Very Satisfied Not Very Satisfied n(%) n(%) n(%) n(%) n(%) n(%) MRS# 1 32 (57) 10 (77) 34 (61) 7 (63) 17 (47) 13 (81) MRS 2 14 (25) 2 (15) 13 (23) 2 (18) 13 (36) 1 (6) MRS 3 10 (18) 1 (7) 9 (16) 2 (18) 6 (17) 2 (13) Collaboration MRS 1 28 (55) 14 ( 8) 26 (54) 15 (79) 20 (53) 10 (71) MRS 2 13 (25) 3 (17) 13 (27) 2 (12) 12 (32) 2 (14) MRS 3 10 (20) 1 (6) 9 (19) 2 (12) 6 (16) 2 (14) p-value * 0.23 0.17 0.46 care 0 ( 6) 22 (67) 2 (63) 9 (5 ) 15 ( 4) 5 (63) 9 (25) 7 (21) 7 (20) 8 (25) 8 (29) 6 (25) 7 (19) 4 (12) 6 ( 7) 5 ( 6) 5 ( 8) 3 ( 3) -value * 0.66 0.94 0.80 Time investment 12 (67) 30 (59) 9 (64) 32 (60) 4 (6 ) 6 (5 ) 3 (17) 13 (25) 3 ( 1) 12 (23) 5 ( 3) 9 (30) S 3 3 ( 7) 8 (16) 2 (14) 9 (17) 3 ( 4) 5 (17) - l .74 1.00 .74 Autonomy MRS 1 32 (64) 10 (53) 32 (65) 9 (50) 23 (55) 7 (70) MRS 2 11 (22) 5 (26) 11 (22) 4 (22) 11 (26) 3 (30) 3 7 ( 4) 4 (21) 6 (12) 5 (28) 8 (19) 0 p-value * 0.64 0.29 0.4 * Fisher exact test, statistically significant (p< 0.05). # MCC = Maternity Care Collaboration. # MRS = models of risk selection. 4. Discussion Exploring the rganization of tasks and responsibilities of primary care midwives and obstetricians in risk selection in The Netherlands, we identified three MRS. We found that the majority of the MCCs work according to the usual MRS, where primary care midwives assess the risk, and initiate a consultation or transfer of care after the booking appointment only if necessary, without discussing this first with the obstetrician. In the second MRS, after the booking a appointment, prima y care midwives assess the risk and make decisions about the consultation or transfer of care collaboratively with obstetricians. The third model consists of models with other characteristics. We did not find significant differences between the MRS and levels of satisfaction. Our survey sho ed at most MCCs in The Neth rlands work accor ing to the usual MRS, where primary care midwives i itiate a consultation or transfer of care only if necessary, without discussing this first with an obstetrician, and conform to the agreements laid down in the division of tasks and responsibilities between midwives and obstetricians in the LMI [13–15]. Experiments in the past decade with MRS included a model in which midwives and obstetricians always collaboratively assess risks and make decisions, which is now used by almost a quarter of the MCCs [13–15]. The MRS vary in several aspects, including routinely scheduled discussions, attending professionals at discussions, and
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