193 General Discussion Primary care midwives have a responsibility to provide appropriate care. This means that in offering aCTGs in MLC, primary care midwives must be careful to avoid an unwarranted increase in medicalization and technocracy, which would unnecessarily interfere with supporting the physiological process of pregnancy. In addition, the quality of the aCTGs must be guaranteed. It is recognized that clinical guidelines need to be as simple and objective as possible if implementation is to be consistent to enable rapid decision-making even in complex and stressful situations.9 In addition, it seems sensible to organize regular and structured integrated training, where healthcare professionals in MLC and OLC interpret aCTGs and evaluate their knowledge together to ensure proper use of technology. Midwives are the gatekeepers of maternity care, whereby good collaboration with network partners is self-evident. It should be noted that the MLC-aCTG innovation has led to improved collaboration between the various professionals in the pilot regions through the establishment of a multidisciplinary working group and transmural working arrangements. If the above conditions are met, MLC-aCTG can be implemented nationally. For the assessment of aCTG, a classification system based on the FIGO classification was used, although the FIGO classification was developed for intrapartum use. The Dutch Federation of Obstetrics and Gynecology, however, also recommends its use for aCTG.10 The evaluation of fetal well-being may be improved in MLC and OLC by the introduction of an internationally accepted and uniform classification system for assessing aCTGs. Another implementation strategy could be the use of computerized CTG, which has been suggested to increase the level of agreement in CTG classification as this assessment is more objective, although it has not been shown to lead to better perinatal outcomes.9,11 Future studies are needed to establish the added value of these strategies in improving the level of agreement in the assessment between and within the professional groups in maternity care. New developments come with challenges, and successful implementation of taskshifting is not self-evident. Research shows that improving the effectiveness of collaboration, cooperation, and transfer between professionals is very complex12, and many collaborative healthcare networks do not achieve their prospected benefits.13 The process of successful uptake requires a transformation of the healthcare system. A blueprint for bridging boundaries in maternity care Although research has shown a discrepancy between the opinions of hospital-based and primary care midwives about the division of roles and responsibilities,14 the implementation of MLC-aCTG is an example of maternity collaborations that have made a start in bridging the existing boundaries between policy, practice, and science. The healthcare professionals in the aCTG pilot have shown that with trust and good collaboration with each other, 7
RkJQdWJsaXNoZXIy MTk4NDMw