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-effectiveness option. However, they still do not represent the mainstream option of maternity care in many countries (1, 2). 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 research about implementation of new MUs was conducted (Prospero protocol reference: CRD42019141443) using PRISMA guidelines (3). Included articles were appraised using the CASP checklist (4). A meta-synthesis approach to analysis was used (5). 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: drivers to open the new MUs and barriers or facilitators to the MU implementation. The latter category included eight key themes: “culture and perceptions”, “healthcare system”, “midwives’ identity and role”, “knowledge, skills and training”, “leadership”, “collaborative approach”, “integration” and “environment”. A logic model was created to explain the role of each during the implementation process. 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 addressing barriers at system, service and individual levels. All three levels need to be addressed when implementing this model of care.

Rol de enfermería en la atención primaria de salud en el manejo del embarazo

“…El embarazo es una etapa única y desafiante en la vida de una mujer, que conlleva cambios físicos, emocionales y sociales significativos (Cordoso et al, 2021). La atención adecuada durante este período crucial es esencial para garantizar el bienestar madre e hijo y reducir la morbimortalidad asociada con el embarazo y el parto (Batinelli et al, 2022). En este contexto,la atención primaria de salud, emerge como el pilar fundamental para brindar una atención integral y personalizada a las mujeres embarazadas, priorizando la promoción de la salud, la prevención de enfermedades y el abordaje temprano de cualquier complicación (Peñafiel et al, 2023).…”