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Barriers and facilitators to the implementation of a midwifery-led care model: a qualitative systematic review
Andreia Soares Goncalves1, Márcia Pestana-Santos2, Christine McCourt3
1Department of Nursing and Midwifery, Escola Superior de Saúde, Instituto Politécnico de Viana do Castelo, Rua Dom Moisés Alves Pinho, 4900-314 Viana do Castelo, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal; CINTESIS@RISE - Innovation & Development in Nursing, Center for Health Technology and Services Research, Rua Dr. Plácido da Costa, 4200-450 Porto, Portugal; Health Sciences Research Unit: Nursing (UICISA:E), Avenida Bissaya Barreto, Polo C, 3046-851 Coimbra, Portugal.
Problem:
Despite the overwhelming benefits of midwifery-led care models, in many countries, for several reasons, there is a resistance to their implementation.
Background:
These care models provide both short-term and long-term advantages for mothers and newborn, demonstrate sustainability, and offer economic benefits.
Aim:
This qualitative systematic review explores and synthesises evidence on stakeholders' perceptions of the barriers and facilitators to implementing a shift from doctor-led or shared-care models to midwifery-led models of care.
Methods:
The review followed Joanna Briggs Institute guidance for qualitative systematic reviews, including a comprehensive database search, study selection, quality appraisal by two independent reviewers, data extraction using a tool for qualitative findings, and thematic synthesis. The Consolidated Framework for Implementation Research guided the organisation and presentation of results, and the credibility and dependability of findings were assessed using ConQual.
Results And Discussion:
Seven studies met the inclusion criteria. Fourteen findings, five facilitators and nine barriers, were identified by stakeholders including women, midwives, doctors and educators. These relate to four implementation domains: innovation, outer setting, inner setting, and individuals. Key themes included cost, local attitudes, local attitudes and conditions, laws and policies, tension for change, relationships, infrastructure, compatibility, access to knowledge, client-centeredness and capability. The review underscores the need for evidence-based strategies to overcome barriers and enhance facilitators.
Conclusion:
Context-specific strategies informed by implementation science must be developed to support the sustainable integration of midwifery-led care models, with a particular emphasis on policy development and stakeholder engagement.
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