[50,70,76,77,111] In the Netherlands, midwives, obstetricians, and neonatologists have their own areas of expertise and practice autonomously. Two-thirds of Dutch midwives work in primary care practices.[112] They are the main care providers for women during pregnancy and birth and serve as gatekeepers. They autonomously conduct risk selection, deciding when referral is necessary to obstetrician-led care or the neonatologist in the hospital. When specialist care is no longer required, women are referred back to their primary care midwife.[113] Objective of this dissertation The overarching objective of this dissertation is to enhance the understanding of risk selection in contemporary MNC, as a means to reduce maternal and newborn morbidity and mortality. The studies were guided by the following research question: What is the nature of, and variation in, risk selection? To answer this research question, we conducted five studies, analysing (1) the concept, (2) the history, (3) the organisation, and (4 and 5) the practice of risk selection in MNC in the Netherlands. We used the following research questions: 1. How is risk selection conceptualized internationally? 2. Why and how did midwives in the Netherlands gain their position as gatekeepers to specialist care? 3. How is risk selection in the Netherlands organized? 4. How do maternal ethnicity, age, parity, socioeconomic status, and gestational age inform risk selection regarding induction of labour? 5. What is the variation in the content of Dutch hospital protocols used in risk selection for neonatal referral to the paediatrician? Outline of this dissertation Chapter 1: Understanding risk selection The lack of clarity about risk selection impedes the evaluation and comparison of models of risk selection (MRS) across various settings. The results of a scoping review into the concept of risk selection are presented in Chapter 1. We systematically searched the scientific literature, examining papers spanning the last four decades. We used inductive thematic analysis to identify key dimensions of risk selection. The results of this study contribute to a shared conceptualisation of risk selection. Chapter 2: The history of risk selection Deciding on a more effective strategy for providing the most appropriate care and care 27 1 GENERAL INTRODUCTION