(SGKL), a committee comprised of representatives from all professions and organisations involved in Dutch MNC. We analysed the minutes of the SGKL’s meetings and conducted interviews with eight key-informants who were involved in the SGKL’s decision process. We used theories of professional jurisdiction and cultural theories of risk to analyse the factors that played a role in redefining the division of tasks and responsibilities in risk selection. The results of this study offer insight into how the authority to undertake risk selection is negotiated at the political and regulatory level. Our study contributes a better understanding of the arguments underlying the design of the system of risk selection, showing the political nature of risk selection, with decisions being determined not only by professionals’ understanding of risk but also by concerns with protecting their interests. These understandings and concerns can differ not only between but also within professions that seek to police and extend their boundaries. Negotiations are shaped by a dynamic interaction between these beliefs and interests, creating the possibility for otherwise unexpected transprofessional coalitions. These insights can reframe policy discussions in MNC, offering the possibility to view disputes in MNC as occurring between beliefs and interests, instead of between professional groups. In chapter 4, we describe the results of a nationwide survey amongst all primary care midwifery practices and obstetric departments undertaken to better understand how risk selection is organized in the Netherlands. We identified three MRS, which were distributed differently across regions: 1) primary care midwives assess risk and initiate a consult or transfer of care without discussing this first with the obstetrician; 2) primary care midwives assess risk and make decisions about consult or transfer care collaboratively with obstetricians; 3) models with other characteristics. We found no significant difference between MRS and levels of satisfaction. An approach that is evidence and value based is recommended as a way to promote optimal organization of risk selection. In chapters 5 and 6, we report on our studies of the effectiveness of the practice of risk selection. We researched the risk factors that inform the selection process and the protocols used to support that process. The results of these studies offer insight into the ways the accuracy of risk selection can be improved. In chapter 5 we studied how maternal age, parity, ethnicity, socioeconomic status, and gestational age inform risk selection regarding induction of labour. Parity and age are increasingly used as single indicators for inducing labour in otherwise healthy women. We analysed whether the use of additional maternal characteristics associated with perinatal mortality would more accurately identify births that would benefit from induction. We conducted a nationwide retrospective cohort study among a healthy Dutch population consisting of all singleton pregnancies in midwife-led care after 37 weeks of gestation in the period 2000-2018. We examined the association of maternal age, parity, ethnicity 11 SUMMARY
RkJQdWJsaXNoZXIy MjY0ODMw