194 Chapter 7 their organizations and client representatives, a successful healthcare improvement is implemented. It may be appropriate to reconsider the current division of tasks between MLC and OLC. We see that healthcare professionals and organizations in the Netherlands are working hard to optimize the role of these professionals in improving continuity of care. Other local experiments have started, such as induction of labor with a Foley catheter or amniotomy at home in pregnancies at 41 weeks’ gestation in an MLC setting.15 In addition, in certain regions midwives provide care during childbirth with moderate-risk indications under the supervision of obstetrician-led care.16 This means that the primary care midwife provides care during childbirth, and the professional in obstetrician-led care is medically responsible. Moderate-risk indications are meconium-stained liquor, prolonged rupture of membranes, use of remifentanil during labor, and preterm labor at 36+0- and 36+6-weeks’ gestation. In countries such as Canada and New Zealand, midwives consult an obstetrician in these case and continue to be medically responsible if labor progresses normally.17-19 The primary care midwife is responsible, which can lead to an increase in hospital capacity and a reduction in healthcare costs. Dutch primary care midwives could be trained to take on other additional tasks in addition to aCTG to care for women with these moderate risk indications. To reduce hospital capacity, certain regions have introduced an antenatal triage center for primary midwifery care, which could contribute to fewer referrals to OLC. Moreover, it is expected to reduce the work load for primary care midwives on call, allowing them to provide more continuity of care during births. In this 24-hour triage center, women are referred by their midwife for a direct assessment during the antenatal or postnatal period (e.g., blood loss, hypertensive symptoms, reduced fetal movements). The triage center may also be a suitable location for MLC-aCTG performance. However, research is recommended to evaluate the results of these experiments. Value-Based Healthcare VBHC and, with it, task-shifting care, requires a different way of working for healthcare providers and maternity care professionals, and confidence in each other’s expertise and competence is needed. The question is how to translate experiments in taskshifting into regular practice at national level. Approaching this question from a technical-rational perspective will provide insights into cost reductions, how best to design this change, and how to divide or share responsibilities. However, the social perspective is also important because it reveals the sentiments, values, and beliefs of the actors.20 The development of MLC-aCTG gives us the opportunity to look more closely at the factors that promote and hinder the creation of integrated care systems (Chapter 6). Midwives have positive and negative feelings about the increased workload, responsibility, dependence on technology and equipment, the impact on their
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