139 Validation of the Birth Beliefs Scale for maternity care professionals in the Netherlands Methods We performed a validation study to validate the Birth Beliefs Scale for maternity care professionals and explored if these birth beliefs contribute to regional practice variation. BOX 1– maternity care in the Netherlands The Dutch maternity care system is equal in all regions in the country. Low-risk women start their antenatal care in midwife-led settings, which is provided by community midwives. Community midwives are qualified to provide antenatal, natal, and postnatal care and are independent healthcare professionals able to make, together with the woman, autonomous decisions about childbirth interventions or referral to obstetric-led care. Indications for a referral from midwife-led to obstetrician-led care are described in the 2003 List of Obstetric Indications. In obstetrician-led care, hospital-based midwives and obstetricians provide care after referral and can provide childbirth interventions such as augmentation of labour, analgesia, and instrumental birth. Community midwives, obstetricians, and other disciplines such as paediatricians and maternity care assistants collaborate regionally in maternity care networks (MCNs). An MCN is usually based around a hospital and the midwifery practices in the same region. The number of professionals involved varies from about 30 to 120, depending on the number of births and the level of urbanisation in the region. Setting This study is part of the VALID study that describes practice variation in induction of labour (IOL) between Maternity Care Networks (MCNs) in the Netherlands (6) (see Box 1). Hereby different mechanisms are explored that influence the decision-making process on IOL. Six MCNs are selected for this study (see Figure 1). Three networks have a high percentage of IOL, and three networks have a low percentage of IOL, categorised based on data of the Dutch national database Perined (6). We focussed on MCNs from the low and high group to explore different mechanisms that influence the IOL rate. The MCNs with a moderate IOL rate are seen as reference group. The Medical Ethical Committee of Zuyderland-Zuyd University confirmed that ethical approval was not required for the VALID study according to the Dutch legislation and regulations (reference METCCZ20210008). 6
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