characteristics in a healthy Dutch population. Studies indicate that there is unwarranted variation in the risk selection process used in the referral of neonates in the Netherlands. Reducing this unwarranted variation requires a comprehensive understanding of the causes of that variation. One of the causes of unwarranted variation in risk selection and subsequent care delivery may be variation between local hospital protocols. In chapter 5, we studied the variation in the local protocols used for neonatal referral. We conducted a nationwide cross-sectional study, comparing the protocols of obstetric and neonatal departments in all hospitals in the Netherlands for the six most common indications for neonatal referral; large for gestational age/macrosomia, small for gestational age/fetal growth restriction, meconium stained amniotic fluid, vacuum extraction, forceps extraction, and caesarean section. 29 1 GENERAL INTRODUCTION