Transitioning to midwifery models of care: lessons from case studies in India

Limited evidence exists on how midwives, other healthcare providers, and their local communities in low- and middle-income countries experience the transition to a midwifery model of care.

This study aimed to identify opportunities, enablers, and barriers to integrating midwifery into existing public health systems, from the perspectives of key stakeholders representing health systems and communities.

We conducted two case studies - community-based and public health facility-based - in Gujarat and Telangana, comprising 63 in-depth interviews and five focus group discussions with 40 participants, including midwives, obstetricians, nurse-midwives, hospital administrators, local women, family members, and community influencers. The ecological systems theory and the quality maternal and newborn care framework guided the framework analysis.

Five themes were developed, each aligning with one level of ecological systems theory: 1) Becoming a midwife; 2) Negotiating the full scope of autonomous midwifery practice; 3) Midwives' integration into existing maternity care teams; 4) Building social recognition of midwifery in communities; and 5) Balancing the care context and policy directives. Midwives had to demonstrate professional competence, confidence, and assertiveness to overcome professional challenges and conflicts and gain acceptance.

Integrating midwifery into existing health systems depends on midwives' acceptance and perceived trustworthiness by existing health teams/communities and can be facilitated by ongoing support and mentoring of midwives, preparatory sensitisation of other healthcare providers, and building social recognition of midwives in communities. Further research is needed to develop and test interventions that support midwives in fulfilling their potential to improve the care quality for mothers and infants.