RESEARCH ARTICLE Towards a better understanding of risk selection in maternal and newborn care: A systematic scoping review Bahareh GoodarziID 1*, Annika Walker1, Lianne Holten1, Linda Schoonmade2, Pim TeunissenID 3,4, Franc¸ois Schellevis5,6, Ank de Jonge1 1 Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, 2 Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, 3 Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, 4 School of Health Professions Education, Maastricht University, Maastricht, The Netherlands, 5 Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, 6 NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands *b.goodarzi@amsterdamumc.nl Abstract Globally, millions of women and their children suffer due to preventable morbidity and mortality, associated with both underuse and overuse of maternal and newborn care. An effective system of risk selection that differentiates between what care should be provided and who should provide it is a global necessity to ensure women and children receive appropriate care, at the right place and the right time. Poor conceptualization of risk selection impedes evaluation and comparison of models of risk selection across various settings, which is necessary to improve maternal and newborn care. We conducted a scoping review to enhance the understanding of risk selection in maternal and newborn care. We included 210 papers, published over the past four decades, originating from 24 countries. Using inductive thematic analysis, we identified three main dimensions of risk selection: (1) risk selection as anorganisational measureto optimally align women’s and children’s needs and resources, (2) risk selection as apracticeto detect and assess risk and to make decisions about the delivery of care, and (3) risk selection as atool to ensure safe care. We found that these three dimensions have three themes in common: risk selection (1) is viewed as both requiring and providing regulation, (2) has aprovider centred focusand (3) aims toavoid underuse of care. Due to the methodological challenges of contextual diversity, the concept of risk selection needs clear indicators that capture the complexity of care to make crosssetting evaluation and comparison of risk selection possible. Moreover, a comprehensive understanding of risk selection needs to consider access disparity, women’s needs, and unnecessary medicalization. Introduction Maternal and newborn care (hereafter, MNC) services fail to meet many of the essential needs of childbearing women (when we use the term ‘woman’, we also refer to individuals with a PLOS ONE PLOS ONE | https://doi.org/10.1371/journal.pone.0234252 June 8, 2020 1 / 22 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Goodarzi B, Walker A, Holten L, Schoonmade L, Teunissen P, Schellevis F, et al. (2020) Towards a better understanding of risk selection in maternal and newborn care: A systematic scoping review. PLoS ONE 15(6): e0234252. https://doi.org/10.1371/journal. pone.0234252 Editor: Russell Kabir, Anglia Ruskin University, UNITED KINGDOM Received: December 17, 2019 Accepted: May 21, 2020 Published: June 8, 2020 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0234252 Copyright: ©2020 Goodarzi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the manuscript and its Supporting Information files. uterus who are not woman identified, including trans men and non-binary individuals) and their unborn or newborn children (hereafter, children). Every year there are an estimated 139 million births worldwide [1]. An estimated 303,000 women die during pregnancy, birth or soon after [2], 2.6 million babies are stillborn [3] and 2.5 million infants die in the first month of life [4]. Maternal and perinatal morbidity and mortality are partly preventable. In the USA, for example, an estimated 63% of pregnancy-related maternal deaths [5] and 27%-54% of infant deaths among children born full-term are avoidable [6]. The Lancet series addressing maternal and newborn health [7–12] emphasized that preventable morbidity and mortality is associated with both underuse and overuse of care. A meta-synthesis in the Lancet series on Midwifery [12] pointed out that childbearing women and their children need a care system that helps them to stay healthy, and that provides a timely transition to medical specialist care for those who develop complications. Pregnancy and birth are primarily physiological processes but risks and complications can occur. The degree and type of risk related to pregnancy and birth differs between women and children, and between countries and care settings. To ensure women and children receive appropriate care, at the right place and the right time, an effective system of risk selection that differentiates between what care should be provided and who should provide it is a global necessity [13,14]. Kennedy and colleagues [15,16] identified the evaluation and comparison of models of risk selection across various settings as one of the top research priorities necessary to improve care. PLOS ONE Risk selection in maternal and newborn care Funding: The author(s) received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. RESEARCH ARTICLE Towards a better understanding of risk selection in maternal and newborn care: A systematic scoping review Bahareh GoodarziID 1*, Annika Walker1, Lianne Holten1, Linda Schoonmade2, Pim TeunissenID 3,4, Franc¸ois Schellevis5,6, Ank de Jonge1 1 Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, 2 Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, 3 Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, 4 School of Health Professions Education, Maastricht University, Maastricht, The Netherlands, 5 Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, 6 NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands *b.goodarzi@amsterdamumc.nl Abstract Globally, millions of women and their children suffer due to preventable morbidity and mortality, associated with both underuse and v ruse of maternal and newborn care. A effective system of risk selection that differentiates between what care should be provided and who should provide it is a global necessity to ensure women and children receive appropriate care, at the right place and the right time. Poor conceptualization of risk selection impedes evalu tion and comparison of mod ls of risk selecti across various settings, which is necessary to improve aternal and newborn care. We conducted a scoping review to enhance the understanding of risk sel ction in m ternal and newborn care. We included 210 pap rs, published over the past four decades, originating from 24 countries. Using inductive thematic analysis, we id ntified three main dimensions of risk selection: (1) risk selection s an rganisational measureto optimally alig women’s and children’s needs and resources, (2) risk selection as apracticeto detect and assess risk and to make decisions about the delivery of care, and (3) risk selection as atool to ensure safe care. We found that these three dimensions have three theme in ommon: risk selection (1) is viewed as both requiring and providing r gulation, (2) has aprovider centred focusand (3) aims toavoid d ruse of car . Due to the methodological challenges of contextual diversity, the concept of risk selection needs clear indicators that capture the complexity of care to make crosssetting evaluation and comparison of risk selection possible. Moreover, a comprehensive understanding of risk selection needs to consider access disparity, women’s needs, and unnecessary medicalization. Introductio Maternal and newborn care (hereafter, MNC) services fail to meet many of the essential needs of childbearing women (when we use the term ‘woman’, we also refer to individuals with a PLOS ONE PLOS ONE | https://doi.org/10.1371/journal.pone.0234252 June 8, 2020 1 / 22 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Goodarzi B, Walker A, Holten L, Schoonmade L, Teunissen P, Schellevis F, et al. (2020) Towards a better understanding of risk selection in maternal and newborn care: A systematic scoping review. PLoS ONE 15(6): e0234252. https://doi.org/10.1371/journal. pone.0234252 Editor: Russell Kabir, Anglia Ruskin University, UNITED KINGDOM Received: December 17, 2019 Accepted: May 21, 2020 Published: June 8, 2020 Peer Review History: PLOS recognizes the benefits f transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0234252 Copyright: ©2020 Goodarzi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the manuscript and its Supporting Information files. 69
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