Midwives' readiness for midwife-led care: a mixed-methods study

To integrate midwife-led care in Belgian maternity services, understanding whether midwives are primed of executing the change is needed.

To explore Belgian midwives' readiness for midwife-led care and understand the underlying processes.

A mixed-methods sequential study: 1) A survey including 414 practising midwives and 2) individual interviews with 12 (student) midwives. General linear model analysis was used to examine the trend between knowledge, self-efficacy and performance mean scores - indicators of midwife-led care readiness - proposed in a 27-item questionnaire. The Readiness Assessment Framework served as a template for qualitative thematic analysis.

Template analysis illustrated the underlying mechanisms of midwifery-led care readiness: Governmental and institutional steering and rule-making functions, regulation and reimbursement, awareness of midwife-led care among stakeholders, capacity to extend primary care postpartum services to antenatal and intrapartum care and healthcare professionals' lack of awareness of available data of women's experiences and midwife-led care efficacy in Belgium. These qualitative findings contribute to the understanding of the significant trend with decreasing function for knowledge, self-efficacy and performance mean scores of 25 midwife-led care readiness indicators, and the two non-significant indicators referring to a physiological postpartum period.

In determining midwife readiness for midwife-led care, we observed adequate knowledge mean scores, associated with low self-efficacy and even lower midwife-led care performance mean scores. Our findings suggest limited readiness for MLC in antenatal and intrapartum care. Belgian midwives are the domain experts of postpartum services but face challenges in extending midwife-led care to antenatal and intrapartum services.