103 4 MODELS OF RISK SELECTION IN MATERNAL AND NEWBORN CARE 2022, 19, 1046 11 of 15 routine visits to the obstetrician. The results of this study can inform other healthcare systems about how risk selection can be organized in different ways. The experiments with MRS were not evidence-based but were prompted by a consensusbased report in 2009, with recommendations to improve the MNC outcomes, such as woman-centered care, preventive care, and accessible care [39]. A specific recommendation was to improve the shared responsibility by a multidisciplinary discussion of all women in a MCC [39] (pp. 32 & 72). Post-humus and colleagues (2013) explored barriers for shared responsibility, including negative financial incentives and a lack of mutual respect [40]. According to them, the usual MRS and the LMI were unique features of the Dutch MNC system and key barriers to shared responsibility, leading to avoidable perinatal mortality [40–42]. However, having agreed guidelines for consultation and transfer of care has been identified as an essential component of successful collaboration in MNC in the international literature [10,43]. Primary care midwives and obstetricians in many other countries use an LMI for consultation and referral to organize tasks and responsibilities, including Canada [22], New Zealand [18], Australia [19], South Africa [20], and England [21]. Belgium is currently developing such a list to support the collaboration between primary care midwives and obstetricians, because an increasing number of women are choosing primary midwifery care [44]. Since the start of the experiments with MRS, only two small experiments were evaluated. Both evaluations used a retrospective cohort design comparing an intervention and a control group. In one experiment, midwives and obstetricians discussed all women who had their booking appointment in primary midwifery care practices. No changes were found in the rates of consultation and transfer of care [13]. The other experiment also included women who had their booking appointment in obstetrician-led care. No changes were found in substitution of care towards primary midwife-led practices and cost reduction [14]. Both experiments did not have the power to evaluate the medical intervention rates and maternal and perinatal morbidity and mortality rates. In both experiments, the women and care providers were satisfied. However, the level of satisfaction was only measured in the intervention group. In this study, we did not find significant differences between the MRS and levels of satisfaction. Previous studies showed that midwives and obstetricians were positive about intensified collaboration. They indicated well-defined responsibilities between midwives and obstetricians, individual responsibility, and collaborative discussions of all women as facilitators of integrated care [45–47]. However, on the one hand, they expressed a preference to remain autonomous in decision-making and organization of care [46,47], while, on the other hand, they considered autonomy as a barrier to integrated care [45]. The three MRS identified in this study differed in the degree of professional individual autonomy, particularly that of primary care midwives. Further in-depth research is needed to better understand the association between level of autonomy and level of satisfaction. In many of the MCCs, healthy women in primary midwifery care were discussed with the obstetrician, or visited the obstetrician at least once during the prenatal period. To our knowledge, the benefits of routine visits to the obstetrician of healthy women with uncomplicated pregnancies in midwife-led models of care remain unknown. Arguably, routine involvement of obstetricians in all healthy pregnancies enhances the continuity of care, because many women in primary midwifery care will eventually be referred to obstetrician-led care at some point during their care [48]. However, routine visits do not necessarily contribute to relational continuity, because the care providers that women see during the visits are often not the same care providers they will see during consultations or birth [49,50]. Informational continuity can be achieved with an electronic medical record accessible by all professionals involved in the care [49]. The continuity of case management is important for women with complex complications, which is facilitated by shared agreements and flexibility in care provision [49]. Lastly, our results indicate that, even though the experiments with MRS were motivated by the desire to improve quality of care [11–14], in some MCCs, factors such as a