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
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design
2.2. Study Population
2.3. Questionnaire
2.4. Data Collection
2.5. Analyses
3. Results
3.1. Characteristics of the Included Primary Midwifery Care Practices and Obstetrics Departments
3.2. Characteristics of Models of Risk Selection
3.3. Models of Risk Selection
3.4. Change in the Usual Organization of Tasks and Responsibilities in Risk Selection
3.5. Level of Satisfaction
4. Discussion
5. Strengths and Limitations
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Primary Midwifery Care Practices | Obstetrics Departments | ||
---|---|---|---|
n (%) | n (%) | ||
Total | 312 (100) | Total | 53 (100) |
Profession | Profession | ||
Primary care midwife | 312 (100) | Hospital-based 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) |
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:
| 16 (23)
|
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) |
Bi-Disciplinary | Multidisciplinary | |
---|---|---|
n (%) | n (%) | |
Discussion is only scheduled at request, and not scheduled routinely. | 9 (13) | 28 (40) |
Discussion is scheduled at request, and scheduled routinely. | 52 (75) | 37 (54) |
Contradictory answers amongst respondents within the MCC *. | 1 (1) | 2 (3) |
Variation within the MCC. | 6 (9) | 0 |
Unclear. | 1 (1) | 2 (3) |
n (%) | |
---|---|
One or more visits to the obstetrician are scheduled routinely for all women in primary midwife-led care. | 1 (1) |
One or more visits to the primary care midwife are scheduled routinely for all women in obstetrician-led care. | 3 (4) |
One or more visits to the obstetrician are scheduled routinely for women with a medium or high-risk profile in primary midwife-led care. | 11 (16) |
One or more visits to the primary care midwife are scheduled routinely for all women in obstetrician-led care, and vice versa to the obstetrician for all women in primary midwife-led care. | 2 (3) |
One or more visits to the primary care midwife are scheduled routinely for women in obstetrician-led care, and vice versa to the obstetrician for women with a medium or high-risk profile in primary midwife-led care. | 1 (1) |
Variation within the MCC *. | 1 (1) |
Unclear. | 4 (6) |
Not mentioned in the answers. | 46 (67) |
MRS * 1 | MRS 2 | MRS 3 | |
---|---|---|---|
n (Row %) | n (Row %) | n (Row %) | |
Total | 42 (61) | 16 (23) | 11 (16) |
North | 3 (33) | 1 (11) | 5 (56) |
East | 9 (64) | 4 (29) | 1 (7) |
South | 2 (14) | 10 (71) | 2 (14) |
Southwest | 12 (75) | 1 (6) | 3 (19) |
Northwest | 16 (100) | 0 (0) | 0 (0) |
Change in the Past Decade | Reversed Change Back to the Usual Model | |
---|---|---|
n (%) | n (%) | |
Total MCCs # | 69 (100) | 50 (100) * |
No | 15 (22) | 41 (82) |
Yes | 46 (67) | 9 (18) |
Variation within the MCC | 4 (5) | |
Contradictory answers amongst respondents within the MCC | 4 (5) |
MCC # | Primary Midwifery Care Practices | Obstetrics Departments | ||||
---|---|---|---|---|---|---|
Very Satisfied | Not Very Satisfied | Very Satisfied | Not Very Satisfied | Very Satisfied | Not Very Satisfied | |
n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | |
Quality of care | ||||||
MRS # 1 | 32 (57) | 10 (77) | 34 (61) | 7 (63) | 17 (47) | 13 (81) |
MRS 2 | 14 (25) | 2 (15) | 13 (23) | 2 (18) | 13 (36) | 1 (6) |
MRS 3 | 10 (18) | 1 (7) | 9 (16) | 2 (18) | 6 (17) | 2 (13) |
Collaboration | ||||||
MRS 1 | 28 (55) | 14 (78) | 26 (54) | 15 (79) | 20 (53) | 10 (71) |
MRS 2 | 13 (25) | 3 (17) | 13 (27) | 2 (12) | 12 (32) | 2 (14) |
MRS 3 | 10 (20) | 1 (6) | 9 (19) | 2 (12) | 6 (16) | 2 (14) |
p-value * | 0.23 | 0.17 | 0.46 | |||
Organization of care | ||||||
MRS 1 | 20 (56) | 22 (67) | 22 (63) | 19 (59) | 15 (54) | 15 (63) |
MRS 2 | 9 (25) | 7 (21) | 7 (20) | 8 (25) | 8 (29) | 6 (25) |
MRS 3 | 7 (19) | 4 (12) | 6 (17) | 5 (16) | 5 (18) | 3 (13) |
p-value * | 0.66 | 0.94 | 0.80 | |||
Time investment | ||||||
MRS 1 | 12 (67) | 30 (59) | 9 (64) | 32 (60) | 14 (64) | 16 (53) |
MRS 2 | 3 (17) | 13 (25) | 3 (21) | 12 (23) | 5 (23) | 9 (30) |
MRS 3 | 3 (17) | 8 (16) | 2 (14) | 9 (17) | 3 (14) | 5 (17) |
p-value * | 0.74 | 1.00 | 0.74 | |||
Autonomy | ||||||
MRS 1 | 32 (64) | 10 (53) | 32 (65) | 9 (50) | 23 (55) | 7 (70) |
MRS 2 | 11 (22) | 5 (26) | 11 (22) | 4 (22) | 11 (26) | 3 (30) |
MRS 3 | 7 (14) | 4 (21) | 6 (12) | 5 (28) | 8 (19) | 0 |
p-value * | 0.64 | 0.29 | 0.44 |
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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 Health 2022, 19, 1046. https://doi.org/10.3390/ijerph19031046
Goodarzi B, Verhoeven C, Berks D, de Vries EF, 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. International Journal of Environmental Research and Public Health. 2022; 19(3):1046. https://doi.org/10.3390/ijerph19031046
Chicago/Turabian StyleGoodarzi, Bahareh, Corine Verhoeven, Durk Berks, Eline F. de Vries, and Ank de Jonge. 2022. "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" International Journal of Environmental Research and Public Health 19, no. 3: 1046. https://doi.org/10.3390/ijerph19031046
APA StyleGoodarzi, B., Verhoeven, C., Berks, D., de Vries, E. F., & de Jonge, A. (2022). 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. International Journal of Environmental Research and Public Health, 19(3), 1046. https://doi.org/10.3390/ijerph19031046