121 Knowledge and skills used for clinical decision-making on childbirth interventions with a high use of childbirth interventions. The reasons for the non-response of the 24 remaining practices are unknown. Participants varied in terms of years of midwifery experience, place of education, and practice characteristics including geographical location (Table 1). We identified three main themes: (I) Knowledge – learning through reflectivity, (II) Critical thinking skills – advanced knowledge in context, and (III) Communication skills – making your knowledge work. An overview of the main themes and subthemes is given in Box 2. Table 1. Characteristics of the participants: primary care midwives working in the Netherlands (N=20) Characteristic Number of participants with low use of interventions (n=13) Number of participants with high use of interventions (n=7) Years of working experience <10 years 10-20 years 20-30 years >30 years 2 5 3 3 2 2 3 0 Place of midwifery training The Netherlands Abroad (Belgium, UK, Switzerland) 12 1 4 3 Practice sizea < 80 80-300 >300 6 5 1 0 4 3 Size of the midwifery team in the practice 1-2 3-4 ≥5 6 4 3 1 3 3 aSize of the midwifery practice in number of women receiving complete care (pregnancy, birth and postpartum) annually. 5
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