What are the strategies for implementing primary care models in maternity? A systematic review on midwifery units

Abstract

Background Midwifery Units (MUs) are associated with optimal perinatal outcomes, improved service users’ and professionals’ satisfaction as well as being the most cost-effective option. However, they still do not represent the mainstream option of maternity care in many countries. Understanding effective strategies to integrate this model of care into maternity services could support and inform the MU implementation process that many countries and regions still need to approach. Methods A systematic search and screening of qualitative and quantitative research about implementation of new MUs was conducted (Prospero protocol reference: CRD42019141443) using PRISMA guidelines. Included articles were appraised using the CASP checklist. A meta-synthesis approach to analysis was used. No exclusion criteria for time or context were applied to ensure inclusion of different implementation attempts even under different historical and social circumstances. A sensitivity analysis was conducted to reflect the major contribution of higher quality studies. Results From 1037 initial citations, twelve studies were identified for inclusion in this review after a screening process. The synthesis highlighted two broad categories: implementation readiness and strategies used. The first included aspects related to cultural, organisational and professional levels of the local context whilst the latter synthesised the main actions and key points identified in the included studies when implementing MUs. A logic model was created to synthesise and visually present the findings. Conclusions The studies selected were from a range of settings and time periods and used varying strategies. Nonetheless, consistencies were found across different implementation processes. These findings can be used in the systematic scaling up of MUs and can help in addressing barriers at system, service and individual levels. All three levels need to be addressed when implementing this model of care.

Implementing midwifery units in a European country: Situational analysis of an Italian case study

“…They can vary in the type of sexual and reproductive health services they provide (e.g., preconception, ante, intra and postpartum or only intrapartum), location (freestanding or alongside a hospital with obstetric services) or their level of integration with the healthcare system (public, integrated or private). Despite the evidence, they are still not well established in many countries (Rayment et al, 2020); therefore, research is now focusing on influences and strategies to support the spread and scaling up of this model of care internationally (Batinelli et al, 2022;Rocca-Ihenacho et al, 2022;Tracy et al, 2005;Walsh et al, 2020). A systematic review of influences on implementation, which included studies from China, US, England, Canada, Brazil and Iran, identified that this type of complex innovation requires a multi-layered approach that address cultural, organisational and professional elements (Batinelli et al, 2022).…”

“…Despite the evidence, they are still not well established in many countries (Rayment et al, 2020); therefore, research is now focusing on influences and strategies to support the spread and scaling up of this model of care internationally (Batinelli et al, 2022;Rocca-Ihenacho et al, 2022;Tracy et al, 2005;Walsh et al, 2020). A systematic review of influences on implementation, which included studies from China, US, England, Canada, Brazil and Iran, identified that this type of complex innovation requires a multi-layered approach that address cultural, organisational and professional elements (Batinelli et al, 2022).…”

Midwife-led birthing centres in four countries: a case study

“…Our study findings also align with similar studies in HICs [ 27 – 30 ] and the frameworks and standards that have been developed based on those studies [ 31 – 33 ]. For example, the following factors have been identified as important in a range of settings as well as in this study: an enabling policy environment including adequate financial and human resourcing, [ 28 – 33 ] mainstreaming MLBCs as a core element of the service rather than as an ‘optional extra’, [ 27 , 28 , 30 ] strong and inspirational midwifery leadership, [ 27 , 28 , 30 ] education and training programmes that prepare midwives with the competence and confidence to support physiological birth and make decisions independently, [ 28 , 30 ] interdisciplinary and interfacility collaboration built on relationships of trust and respect [ 28 , 30 ]. Supportive leadership helps create a positive work environment for midwives, encouraging their professional development and job satisfaction.…”

Planning and implementing practice changes in Ontario maternal-newborn hospital units: a secondary qualitative analysis

“…Within maternal-newborn care, there are increasing examples of implementation science applications, focusing on topics such as prioritizing content areas for implementation research [ 11 ] and practice [ 12 ], identifying and examining the effectiveness of different implementation strategies [ 13 – 15 ], and exploring barriers and facilitators to implementation [ 15 – 17 ]. While this literature makes an essential contribution to advancing our understanding of evidence-informed strategies to implement evidence and the potential challenges, it typically has not focused on the entire implementation process needed to bring about change (i.e., taking a planned action [ 18 ] approach to changes).…”