Midwives’ perspectives on risk classification in the German maternity record (Mutterpass): an exploratory survey

OBJECTIVES: Risk stratification in pregnancy based on Catalogue A in the German maternity record (Mutterpass) represents an established component of antenatal care. The aim of the study is to explore the perspectives and opinions of German midwives on the current risk classification during pregnancy. METHODS: Between May and July 2025, midwives across Germany were surveyed using the online REDCap platform regarding their opinions on the current risk classification in pregnancy. As part of the FeMaR (Fetomaternal Risk Score) project, this exploratory survey among healthcare professionals was conducted prior to the development of a future pregnancy risk stratification model. Participation was anonymous and voluntary, with one response permitted per device. Quantitative data were analysed using descriptive statistics. RESULTS: Data from 220 midwives were included in the analysis. More than half of respondents reported that the current risk classification is largely subjective and lacks specificity. Suggested approaches for further development included weighting individual risk factors, re-evaluating risk over the course of pregnancy, and enabling a more differentiated assessment of individual risk constellations. Midwives additionally emphasized the relevance of social determinants of health, experiences of violence, physical activity, and dietary habits in the context of pregnancy risk stratification. CONCLUSIONS: These findings support existing evidence that pregnancy- and birth-related risks vary substantially depending on individual risk factors and may change over the course of pregnancy. From the midwives' perspectives, there appears to be a need for more differentiated and dynamically adaptable approaches to pregnancy risk stratification in future clinical care.