93 Citation: Goodarzi, B.; Verhoeven, C.; Berks, D.; de Vries, E.F.; de Jonge, A. Models of Risk Selection in Maternal and Newborn Care: Exploring the Organization of Tasks and Responsibilities of Primary Care Midwives and Obstetricians in Risk Selection across The Netherlands. Int. J. Environ. Res. Public Health2022, 19, 1046. https://doi.org/10.3390/ ijerph19031046 Academic Editor: Paul B. Tchounwou Received: 5 November 2021 Accepted: 15 January 2022 Published: 18 January 2022 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). Models of Risk Selection in Maternal and Newborn Care: Exploring the Organization of Tasks and Responsibilities of Primary Care Midwives and Obstetricians in Risk Selection across The Netherlands Bahareh Goodarzi 1,*, Corine Verhoeven1,2,3, Durk Berks 4, Eline F. de Vries 5,6 and Ank de Jonge 1 1 Department of Midwifery Science, AVAG, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands; c.verhoeven@amsterdamumc.nl (C.V.); ank.dejonge@amsterdamumc.nl (A.d.J.) 2 Queen’s Medical Centre, Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK 3 Maxima Medical Centre, Department of Obstetrics and Gynaecology, De Run 4600, 5504 DB Veldhoven, The Netherlands 4 Department of Obstetrics and Gynaecology, Dijklander Ziekenhuis, Maelsonstraat 3, 1624 NP Hoorn, The Netherlands; durk@berks.nl 5 National Institute for Public Health and the Environment, Department of Quality of Care and Health Economics, P.O. Box 1, 3720 MA Bilthoven, The Netherlands; eline.de.vries@rivm.nl 6 Department of Public Health and Primary Care, Campus the Hague, Leiden University Medical Center, 2511 DP Den Haag, The Netherlands * Correspondence: b.goodarzi@amsterdamumc.nl; Tel.: +31-20-444-5479 Abstract: An effective system of risk selection is a global necessity to ensure women and children receive appropriate care at the right time and at the right place. To gain more insight into the existing models of risk selection (MRS), we explored the distribution of different MRS across regions in The Netherlands, and examined the relation between MRS and primary care midwives’ and obstetricians’ satisfaction with different MRS. We conducted a nationwide survey amongst all primary midwifery care practices and obstetrics departments. The questionnaire was completed by 312 (55%) primary midwifery care practices and 53 (72%) obstetrics departments. We identified three MRS, which were distributed differently across regions: (1) primary care midwives assess risk and initiate a consultation or transfer of care without discussing this first with the obstetrician, (2) primary care midwives assess risk and make decisions about consultation or transfer care collaboratively with obstetricians, and (3) models with other characteristics. Across these MRS, variations exist in several aspects, including the routine involvement of the obstetrician in the care of healthy pregnant women. We found no significant difference between MRS and professionals’ level of satisfaction. An evidence- and value-based approach is recommended in the pursuit of the optimal organization of risk selection. This requires further research into associations between MRS and maternal and perinatal outcomes, professional payment methods, resource allocation, and the experiences of women and care professionals. Keywords: maternal and newborn care; healthcare organization; risk selection; decision-making; value-based healthcare 1. Introduction Globally, high rates of preventable morbidity and mortality persist for childbearing women and their children (when we use the term ‘woman’, we also refer to individuals with a uterus who are also not woman identified, including trans and non-binary individuals) [1–4]. Preventable morbidity and mortality are associated with both underuse and overuse of care [5–7]. To ensure women and children receive appropriate care necessitates
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