Implementation of midwifery units in the Portuguese context: Barriers and facilitators
Sara D C Paz1, Andreia S Goncalves2, Filipa Sampaio3
1Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, R. Jorge de Viterbo Ferreira 228, Porto 4050-313, Portugal.
Background:
In Portugal, childbirth predominantly occurs in Obstetric Units, even for low-risk pregnancies, often resulting in excessive medical interventions. Midwifery Units, successfully integrated into health systems comparable to the Portuguese National Health System may be a viable alternative.
Aim:
This study explores stakeholders' perceptions of the barriers and facilitators to the implementation of Midwifery Units in Portugal.
Methods:
A qualitative, descriptive-exploratory study was conducted using semi-structured interviews for data collection.
Findings:
Two overarching themes emerged: implementation readiness and implementation strategies. The first encompasses cultural, organizational, professional, and political dimensions. The second focuses on the professional positioning of midwifery in Portugal, its hierarchical relationship with other healthcare professions, and the structural characteristics of the health system.
Discussion:
The primary barriers to implementing Midwifery Units are deeply rooted in the prevailing physician-led maternity care model in Portugal. However, the current challenges within the National Health System, along with ongoing restructuring efforts, create an opportunity for change. Key facilitators include the aim of reducing unnecessary interventions, promoting humanized care, expanding women's autonomy in childbirth, and aligning practices with contemporary scientific evidence.
Conclusion:
The study highlights that while structural and cultural barriers persist, a convergence of social, professional, and institutional facilitators may offer a strategic window for integrating Continuity of Midwife Care in Portugal. Tailored implementation strategies, interprofessional collaboration, and policy advocacy are required to translate existing evidence into national practice.
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