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Assessing stakeholders' acceptability of implementing the midwifery continuity of care model in China: a convergent
Chunlan Yu1,2, Sulin Dong1, Xiaojiao Wang1,3
1Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai Key Lab of Reproduction and Development, Shanghai Key Lab of Female Reproductive Endocrine Related Diseases, Shanghai, China.
Background:
The midwifery continuity of care (MCoC) model, in which a known midwife or small team provides coordinated care throughout pregnancy, birth, and the postnatal period, is recommended internationally. In China, however, maternity care remains predominantly obstetrician-led and fragmented. Successful implementation of MCoC critically depends on stakeholder acceptance, yet evidence on their perspectives in the Chinese context is scarce. This study aimed to assess the acceptability of implementing the MCoC model among maternity care providers and childbearing women in China.
Methods:
A convergent parallel mixed-methods design was adopted. Nationwide cross-sectional surveys were administered to 896 maternity care providers, and focus group discussions were conducted with care providers and childbearing women. Quantitative data were analyzed using descriptive statistics and chi-square tests; qualitative data were analyzed inductively using thematic analysis.
Results:
Among the 896 providers (median age 35 years), 835 (93.2%) expressed willingness to accept and implement the MCoC model in clinical practice. Acceptability varied significantly by stakeholder group (P < 0.05), being highest among midwives (96.7%), followed by obstetric nurses (93.5%) and obstetricians (88.9%). Key facilitators included supportive leadership (95.3%), endorsement from obstetricians (79.8%) and buy-in from pregnant women (77.9%), as well as support from collaborating hospitals (63.0%). Qualitative analysis yielded four main themes: (1) High feasibility of implementing the MCoC model; (2) Women's unmet needs for relational continuity within current maternity care; (3) Positive expectations toward the MCoC model; and (4) Barriers to implementing the MCoC model.
Conclusions:
The acceptability of the MCoC model was high among stakeholders in China. Supportive leadership, targeted education and training, and strategic publicity are crucial for its successful introduction and scale-up.
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