98 4 CHAPTER 4 2022, 19, 1046 6 of 15 We received a response from 69 out of the 71 MCCs (96%). In four (6%) MCCs, we received a response from all primary midwifery care practices and obstetrics departments that were members of that MCC. In 17 of the 69 MCCs (25%), we received no response from the obstetrics departments. In two (3%) MCCs, we received no response from primary midwifery care practices. The size of the primary midwifery care practices and obstetrics departments ranged 30–2000 care units and 650–4000 births per year, respectively. Fortythree (14%) primary midwifery care practices reported being a member of two MCCs, and five primary midwifery care practices (2%) reported being member of three MCCs. No obstetrics departments reported being member of more than one MCC. In eight (12%) MCCs, one or two primary midwifery care practices reported the membership of an MCC, that was not confirmed by the obstetrics departments. Sixty-one (20%) primary midwifery care practices reported collaborations with a maximum of four hospitals outside their MCC. 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 highrisk 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(%) 11 (16) 0 (0) 52 (75) 6 (9) 42 (61) Only for women who had a booking appointment with a primary care midwife; All women. 16 (23) - 14 (20) - 2 (3) 4 (6) 3 (4) 4 (6) 100 (100) 0 (0) 0 (0) * MCC = Maternity Care Collaboration. Int. J. Environ. Res. Public Health 2022, 19, 1046 6 of 15 We received a response from 69 out of the 71 MCCs (96%). In four (6%) MCCs, we received a response from all primary midwifery care practices and obstetrics departments that were members of that MCC. In 17 of the 69 MCCs (25%), we received no response fro the obstetrics departments. In two (3%) MCCs, we received no response from primary midwifery ca rac ices. The size of th primary midwifery care practices and obstetrics depa t ents ranged 30–2000 care uni s and 650–4000 births p r yea , res ectively. Fortythree (14%) primary midwifery care practices reported being a me ber of two MCCs, and five primary midwifery care practices (2%) reported being member of three MCCs. No obstetrics departments reported being member of more than one MCC. In eight (12%) MCCs, one or two primary midwifery care practices reported the membership of an MCC, that was not confirmed by the obstetrics departments. Sixty-one (20%) primary midwifery care practices reported collaborations with a maximum of four hospitals outside their MCC. 3.2. Characteristics of Models of Risk Selection The results of the organization of the tasks and responsibilities at the level of MCCs are s own in Tables 2–4. Table 2 shows that, in most MCCs, all women with uncomplicated pregnan ies started their c re in primary midwifery care practices, and women wi h a highrisk 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 an sometimes cheduled 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 obstetrician-led care in the hospital. Primary care midwives are responsible for the booking appointment for women with uncomplicated pregnancies and obstetricians are responsible for the booking appointment of women with a high-risk profile. 52 (75) Contradictory answers amongst respondents within the MCC *. 6 (9) Organization of tasks and responsibilities regarding risk assessment after booking appointment. Primary care midwives assess risk and initiate a consultation or transfer of care only if necessary, without discussing this first with the obstetrician. 42 (61) Risk is assessed collaboratively. Primary care midwives and obstetricians discuss whether a consultation or transfer of care is necessary: - Only for women who had a booking appointment with a primary care midwife; - All women. 16 (23) - 14 (20) - 2 (3) Contradictory answers amongst respondents within the MCC. 4 (6) Variation within the MCC. 3 (4) Unclear. 4 (6) Organization of tasks and responsibilities in decision-making after discussion between primary care midwives and obstetricians. Primary care midwives and obstetricians are together responsible for decision-making. 100 (100) Primary care midwives are responsible for decision-making. 0 (0) Obstetricians are responsible for decision-making. 0 (0) * MCC = Maternity Care Collaboration.
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