Using codesign to support the implementation of a midwifery unit in Europe

Midwifery units (MUs) have demonstrated to be a safe and cost-effective model of maternity care. Several European countries do not offer this model yet but are working towards its implementation to improve perinatal outcomes, service users' and midwives' satisfaction while making effective use of healthcare resources. Few research projects have focused on the implementation aspect. This study observed and supported the process for implementation of a new MU in Italy using participatory action research (PAR) and codesign.

A 4-stage project was conducted to codesign an implementation plan aimed at supporting the transition from the obstetrically led maternity unit to an integrated model with a MU. The study engaged maternity professionals, managers and service users via online focus groups and eSurveys.

Participants identified ten themes to focus the implementation work on: team vision, creation of a multidisciplinary advisory group, creation of a dedicated group of midwives, implementation of intrapartum guidelines for low-risk women, appropriate risk assessment, integration hospital-community, training, effective communication and information for service users and within the team, and reflective practice. Service users supported the initiatives proposed in the implementation plan and expressed openness towards the model of care and its implementation.

This was the first study using codesign and PAR including maternity team, managers and service users to support the implementation of a MU. This work showed value in a collaborative codesign approach. While this work is adapted to the Italian context, the process and findings could be useful in other international contexts.