97 4 MODELS OF RISK SELECTION IN MATERNAL AND NEWBORN CARE 2022, 19, 1046 5 of 15 midwifery care practices and obstetrics departments that responded. We found an unequal representation of obstetrics departments. Therefore, in September 2020, all nonresponding obstetrics departments received a reminder phone call. The characteristics of the included primary midwifery care practices and obstetrics departments are presented in Table 1. Int. J. Environ. Res. Public Health 2022, 18, x FOR PEER REVIEW 6 of 16 Figure 1. Study population. 3.2. Characteristics of Models of Risk Selection The results of the organization of the tasks and responsibilities at the level of MCCs are shown in Tables 2–4. Table 2 shows that, in most MCCs, all women with uncomplicated pregnancies started their care in primary midwifery care practices, and women with a high-risk profile or with existing complications started their care in secondary obstetrician-led care in the hospital. Primary care midwives assessed the risk and initiated a consultation or transfer of care only if necessary, without discussing this first with the obstetrician. Bi-disciplinary discussions between primary care midwives and obstetricians were sometimes scheduled upon request and sometimes scheduled routinely. After discussion, primary care midwives and obstetricians together made decisions regarding a consultation or transfer of care. Table 2. The booking appointment, risk assessment after booking appointment, and decision-making after discussion between primary care midwives and obstetricians (n,%). The Organization of Tasks and Responsibilities Regarding the Booking Appointment n (%) All women start their care in primary midwifery care practices, regardless of their risk profile. Primary care midwives are responsible for the booking appointment. 11 (16) All women start their care in secondary obstetrician-led care in the hospital, regardless of their risk profile. Obstetricians are responsible for the booking appointment. 0 (0) All women with uncomplicated pregnancies start their care in primary midwifery care, and women with a high-risk profile start their care in secondary obstetricianled care in the hospital. 52 (75) Figure 1. Study population. Table 1. Characteristics of the responding primary midwifery care practices and obstetrics departments (n,%). Primary Midwifery Care Practices Obstetrics Departments n(%) n(%) Total 312 (100) Total 53 (100) Profession Profession Primary care midwife 312 (100) Hospital-ba ed midwife 9 (17) Midwife working both as primary care midwife and hospital-based midwife 1 (2) Obstetrician 30 (57) Manager 13 (25) Number of care units/year 1 Number of births/year 2 ≤250 181 (58) ≤1000 10 (19) 251–500 117 (38) 1001–2000 21 (40) 501–750 11 (4) 2001–3000 15 (21) ≥751 3 (1) ≥300–4000 6 (12) 1 Care by primary care midwives in The Netherlands are reimbursed on an episode-based payment basis of the average costs of prenatal, natal, and postnatal care of one woman. Missing: 2 (0.6). 2 Care by obstetricians in The Netherlands is reimbursed on a fee for service basis. Missing: 1 (0.3). Int. J. Environ. Res. Public Health 2022, 19, 1046 5 of 15 midwifery care practices and obstetrics departments that responded. We found an unequal representation of obstetrics departments. Therefore, in September 2020, all nonresponding obstetrics departments received a reminder phone call. The characteristics of the included primary midwifery care practices and obstetrics departments are presented in Table 1. Int. J. Environ. Res. Public Health 2022, 18, x FOR PEER REVIEW 6 of 16 Figure 1. Study population. 3.2. Characteristics of Models of Risk Selection The results of the rganization of the tasks a d respon ibili ies at th level of MCCs are shown in Tables 2–4. Table 2 shows that, in most MCCs, all women with uncomplicated pregn ncies started their care in primary midwifery care practices, and women with a high-risk profile or with existing complications started their care in secondary obstetrician-led care in the hospital. Primary care midwives assessed the risk and initiated a consultation or transfer of care only if necessary, without discussing this first with the obstetrician. Bi-disciplinary di cussions between primary care midwives and obstetricians were sometimes scheduled upon request and sometimes scheduled routinely. After discussion, primary care midwives and ob tetricians together made decisions regarding a consultation or transfer of care. Table 2. The booking appointment, risk assessment after booking appointment, and decision-making after discussion between primary care midwives and obstetricians (n,%). The Organization of Tasks and Responsibilities Regarding the Book ng Appointmen n (%) All women start their care in primary midwifery care practices, regardless of their risk profile. Primary care midwives are responsible for the booking appointment. 11 (16) All women start their care in secondary obstetrician-led care in the hospital, regardless of their risk profile. Obstetricians are responsible for the booking appointment. 0 (0) All women with uncomplicated pregnancies start their care in primary midwifery care, and women with a high-risk profile start their care in secondary obstetricianled care in the hospital. 52 (75) Figure 1. Study population. Table 1. Characteristics of the responding primary midwifery care practices and obstetrics departments (n,%). Primary Midwifery Care Practices Obstetrics Departments n(%) n(%) Total 312 (100) Total 53 (100) Profession Profession Primary care midwife 312 (100) Hospital-ba ed midwife 9 (17) Midwif working both as primary care midwife and hospital-based midwife 1 (2) Obst trician 30 (57) Manager 13 (25) Number of care units/year 1 Number of births/year 2 ≤250 181 (58) ≤1000 10 (19) 251–500 117 (38) 1001–2000 21 (40) 501–750 11 (4) 2001–3000 15 (21) ≥751 3 (1) ≥300–4000 6 (12) 1 Care by primary care midwives in The Netherlands are reimbursed on an episode-based payment basis of the average costs of prenatal, natal, and postnatal care of one woman. Missing: 2 (0.6). 2 Care by obstetricians in The Netherlands is reim ursed on fee for service basis. Missing: 1 (0.3).
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