94 4 CHAPTER 4 2022, 19, 1046 2 of 15 a maternal and newborn care (MNC) system focused on promoting health, preventing complications, and warranting timely transition to medical specialist care if needed [2]. Effective risk selection is essential to achieve appropriate MNC [8,9]. Internationally, risk selection is used as an organizational measure to optimally align childbearing women’s needs and MNC resources, ensuring that care is provided by healthcare professionals with the appropriate level of expertise, in the most appropriate place, where the appropriate facilities and resources are located, and with the type and timing of care planned appropriately [10]. In The Netherlands, midwives and obstetricians aim to optimize the organization of tasks and responsibilities in risk selection through an integrated, multidisciplinary approach in order to improve care outcomes. This has opened the door to experiments with different models of risk selection (MRS) [11–15]. Historically, MNC has been organized into primary midwife-led care and obstetrician-led hospital-based care [16,17]. Similar to other countries, midwives and obstetricians use a national multidisciplinary evidence-based list of medical indications for consultation and transfer of care to obstetricians (LMI) [18–22]. This list includes agreements about the division of tasks and responsibilities between midwives and obstetricians regarding risk selection [16,17]. Primary care midwives are the primary caregivers for women with a healthy and uncomplicated pregnancy and birth. As ‘gatekeepers’, they are also responsible for risk selection: they identify women with risk factors or complications and initiate a consultation or transfer of care to obstetrician-led care in the hospital. These women give birth in the hospital under supervision of the obstetrician. When specialist care is no longer required, women are referred back to the primary care midwife, where they can choose to either give birth at home, in a birth center, or in the hospital under supervision of the primary care midwife [16,17]. Over the past several years, in some regions, obstetricians have become routinely involved in risk selection, although their tasks and responsibilities vary considerably. In other regions, primary care midwives’ tasks and responsibilities have been extended, including the assessment of women with high-risk profiles [13–15]. Until now, these experiments have not been systematically evaluated, which impedes comparisons of the different MRS. The evaluation and comparison of MRS across various settings has been identified as one of the top research priorities necessary to improve MNC [23,24]. A recent scoping review into risk selection showed that the organization of risk selection is highly contextualized, determined by numerous factors, including geography, demography, government policy, laws and regulations, history, and culture. The contextual relativity of risk selection is a major challenge for the study of risk selection. The improvement of risk selection can only be achieved through context-specific research with an understanding of the variation in MRS [10]. Additionally, these studies are necessary for an evidence-based reform of MRS. Therefore, we explored the different MRS across The Netherlands in terms of the organization of tasks and responsibilities between primary care midwives and obstetricians and the distribution across regions. We also examined the relation between primary care midwives’ and obstetricians’ level of satisfaction and different MRS. 2. Materials and Methods 2.1. Design In this nationwide study, we used a questionnaire to gain insight into the organization of tasks and responsibilities of primary care midwives and obstetricians in the different MRS The Netherlands. 2.2. Study Population In The Netherlands, approximately two-thirds of midwives work in primary midwifery care community-based practices. The remaining one-third practice in the hospital under supervision of an obstetrician and are referred to as hospital-based midwives [25]. Regionally, hospitals and the surrounding primary midwifery care practices are organized into 71 Maternity Care Collaborations (MCC) [26]. MCCs vary in many aspects, including