24 Chapter 2 MATERIALS AND METHODS Study design We conducted a prospective study among four professional groups involved in Dutch maternity care. All were purposively selected from different parts of the country. The participants were provided with written information about the aim and procedure of the study and gave their written informed consent. Data about the aCTG assessments by all participants were collected between January 25, 2021 and August 29, 2021. The identity of the participants was anonymized and processed confidentially in an SPSS file. The aCTG traces used in the study were not traceable to patients. Ethical approval was requested from the Medical Ethics Committee of VU University Medical Center. They deemed the Medical Research Involving Human Subjects Act not to be applicable to our study (VUmc MEC, no. 2016.484). Setting In the Netherlands, pregnant women at low risk receive midwife-led care from primary care midwives, while women at high risk receive obstetrician-led care from obstetricians, residents, and hospital-based midwives.15 When a risk factor or a complication arises during pregnancy or childbirth, the midwife refers the woman to obstetrician-led care for consultation or transfer of care. Participants All care professionals acquired CTG assessment skills during their initial training and are legally authorized to perform CTGs. To acquire competence in performing an aCTG, the primary care midwives providing aCTGs followed a 2-day course concluded with an examination. The course consisted of the theoretical background of the CTG, the assessment of a CTG according to the International Federation of Gynecology and Obstetrics (FIGO) guidelines,16 skills needed to carry out aCTG, and training in clinical decision-making taking into account the woman’s overall well-being. To maintain competence, primary care midwives attended at least four multidisciplinary quality meetings annually with an obstetrician, organized in each region, about interpreting and evaluating aCTGs. The participating hospital-based midwives, residents, and obstetricians were already performing aCTG monitoring daily in clinical settings and were therefore, not obligated to follow a course and attend quality meetings. Measurement The participants were recruited by email. Each participant received personal login details for the Castor Electronic Data Capture system. In this secure environment,
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