210 Appendices an important role in the clinical decisions that are made. Often, research is focused on risk groups, risk factors for adverse outcomes or factors on mesolevel, rather than on the role of the healthcare professional in clinical decisions. The studies performed at meso-level have contributed to the body of knowledge about how factors like guidelines and collaboration influence maternity care professionals in their clinical decisions about the use of interventions. Our studies help to understand how recommendations in regional protocols and differences in birth beliefs of healthcare professionals are factors in practice variation in maternity care. We have focused on these factors, but there are more factors that interact in the mechanism of practice variation. More research is needed to investigate these factors and how they contribute to the clinical decision-making process. Target groups This thesis explores the variation in childbirth interventions in the Netherlands and generates further knowledge about how personal and professional factors are related to midwives’ clinical decisions about the use of childbirth interventions. Accordingly, our findings are of interest to maternity care professionals, researchers, and policymakers in the Netherlands. Because we focused on midwives’ clinical decision-making, this thesis is of particular interest to the Dutch Association of Midwives (KNOV) and the midwifery educational programmes. Insights into regional protocol development and birth beliefs of different maternity care professionals provide knowledge for collaboration within Maternity Care Networks, and are therefore of interest to organisations that support Maternity Care Networks, such as the College Perinatale Zorg (CPZ), Federatie van VSV’s, and regional consortia. The knowledge of national guideline development and the regional implementation of national guidelines is of use for the national associations of midwives, obstetricians, and paediatricians as well as the CPZ, where all professional associations coordinate together. Together they can improve the national guideline development procedures and make them more compatible. This will improve regional maternity care as well as care for the client. Although our research was conducted in the Netherlands, knowledge about midwives’ clinical decisions about the use of childbirth interventions go beyond the Dutch context, they are also relevant for an international audience of maternity care professionals, researchers and policymakers. Activities As a practising midwife, I am a board member of the regional maternity care network. The board is responsible to assure the quality of care in this region, part of my role is to generate insight into intervention rates and set up quality improvement programmes. At a national level, I disseminate my knowledge of practice variation as a professional expert in meetings on practice variation among 18 different Maternity Care Networks.
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