32 Chapter 2 This study showed that the quality of aCTG assessment is equally good for primary care midwives, hospital-based midwives, residents, and obstetricians. In addition, our previous work showed high satisfaction among women and reassuring maternal and perinatal outcomes after aCTG.27, 28 We therefore recommend reconsidering the current strict task division between primary care midwives and obstetrician-led care and optimizing the roles of these professionals, hereby contributing to accessible care. However, continued governance of quality of care in midwife-led and obstetrician-led care remains an important issue. For the assessment of aCTG, a classification system based on the FIGO classification was used, although FIGO originally was developed for intrapartum use. The Dutch Federation of Obstetrics and Gynecology, however, also recommends using it for aCTG.18 The authors recommend implementing an internationally accepted classification system for assessing aCTGs. Another implementation strategy could be using computerized CTG, which has been suggested to increase the level of agreement on CTG classification since this assessment is more objective, although it did not lead to better perinatal outcomes.29 Future studies are needed to establish the added value of these strategies to the level of agreement in the assessment between and within the professional groups in maternity care. Acknowledgement We would like to thank Iris Eekhout for her consultation role during the analysis. We would also like to thank the participants for their contributions to this study.
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