95 4 MODELS OF RISK SELECTION IN MATERNAL AND NEWBORN CARE 2022, 19, 1046 3 of 15 the involvement of other professionals in multidisciplinary discussions—such as pediatricians, general practitioners, maternity care assistants, social workers, and child health nurses—and the way in which discussions between professionals take place, for example, face-to-face, by telephone, by e-mail, or by video call. 2.3. Questionnaire A web-based questionnaire was designed by the members of the research team. The questionnaire consisted of four sections. Section one contained questions about the characteristics of primary midwifery care practices and obstetrics departments. Sections two and three of the questionnaires were based on the LMI [16,17]. We asked questions about the division of tasks and responsibilities between primary care midwives and obstetricians regarding the booking appointment, risk assessment after the booking appointment, whether discussions were routinely scheduled or not, the location and moment of these discussions, which professionals attended these discussions, and the decision-making after these discussions. These questions were specified for five categories of medical risk—uncomplicated, medium-risk, high-risk, unclear risk, and psychosocial risk. We used multiple choice questions and open fields for remarks. The fourth section contained questions about the level of satisfaction with the organization of the risk selection. We requested and received feedback from the College for Perinatal Care (a collaboration between obstetricians, midwives, pediatricians, maternity care assistants, hospitals, insurance companies, and The Netherlands Patient Federation committed to enhance the integration of maternal and newborn care (https://www.kennisnetgeboortezorg.nl/) access date: 1 October 2021); the Federation of Maternity Care Collaborations (a collaboration between the representatives of MCCs (https://www.federatievsv.nl/) access date: 1 October 2021); the Child and Hospital Foundation (represents children and their families in medical care (https://kindenziekenhuis.nl/) access date: 1 October 2021); The Dutch Society of Obstetrics and Gynecology [27]; the Royal Dutch Organization of Midwives [28]; and an independent advisor in obstetrics and perinatology. The questionnaire was pilot tested in two stages in August and September 2019 by six primary care midwives, four hospital-based midwives, and two research assistants. The pilot test resulted in minor adjustments to the questionnaire, including clarification of the categories of medium-risk and high-risk, changes in the ranges for the number of care, and number of births and the need to purposively invite participants with knowledge about the agreements about the risk selection processes. 2.4. Data Collection Data was collected in the period October 2019 to September 2020 using Castor EDC software (2019) [29]. We invited all primary midwifery care practices and obstetrics departments across the 71 MCCs in The Netherlands to participate in this study. Invitations were sent by e-mail in October 2019. At the time of the study, an up-to-date overview of primary midwifery care practices did not exist. Therefore, we used an overview provided by the three Midwifery Academies, the Perined data register (the Dutch national perinatal register, which includes data on pregnancies and births collected from primary care midwives, obstetricians, and pediatricians (https://www.perined.nl/) access date: 1 October 2021), and the College for Perinatal Care. Missing e-mail addresses of primary midwifery care practices and obstetrics departments were obtained from the internet or by phone. To make sure we did not miss any primary midwifery care practices and obstetrics departments, and to achieve a high response rate, we announced the study in widely read media amongst midwives and obstetricians, including the College for Perinatal Care’s newsletter [30], the Dutch journal for midwives [31], the Dutch journal for obstetricians and gynecologists [32], Kennispoort Verloskunde [33], and social media. The study invitation, containing information about the study and a link to the questionnaire, was sent to 569 (99.8%) primary midwifery care practices and 74 (100%) obstetrics departments. We invited professionals in each primary midwifery care practice and obstet-
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