The basis of the Dutch obstetric system: risk selection

The Dutch obstetric system is based upon risk selection and risk management. The level of care is matched to the level of risk. Low-risk patients are assigned to primary care and the others to secondary care. As risk factors can arise during the course of pregnancy, delivery, and puerperium, this is a dynamic process. The organization is described and an overview of various Dutch studies of this system and the changes of referral rates in the course of time are given.