Understanding the implementation of continuity-enhancing innovations as steps towards midwife-led continuity of care:...

Area of Science:

• Maternal Health
• Healthcare Systems Research
• Implementation Science

Background:

• Midwife-led continuity of care models are increasingly recognized for improving maternal and infant outcomes.
• Collaboration between community midwives and hospital professionals presents unique implementation challenges.
• Understanding the factors influencing the adoption and sustainability of these models is essential for healthcare system improvement.

Purpose of the Study:

• To investigate the implementation and sustainability of midwife-led continuity of care elements within collaborative maternity care systems.
• To analyze how different stakeholders perceive and engage with these care models.

Main Methods:

• Qualitative explanatory study utilizing Normalization Process Theory.
• Semi-structured interviews conducted with diverse stakeholders (midwives, obstetricians, managers, insurance employees) across nine maternity care networks.
• Purposive and theoretical sampling strategies employed for participant recruitment.

Main Results:

• Strong conceptual support for midwife-led continuity of care did not consistently translate into practical action.
• Trust between stakeholders and financial feasibility emerged as critical themes influencing implementation.
• Trust developed incrementally but was fragile in competitive environments; financial structures significantly impacted engagement.

Conclusions:

• Successful implementation and normalization of midwife-led continuity of care depend heavily on stakeholder trust and financial feasibility.
• Trust and financial alignment are dual preconditions for adopting and acting on collaborative care models.
• Transformative change in fragmented systems necessitates simultaneous investment in relationships and financial redesign.