Midwife-Led Care as a Global Strategy for Safer Childbirth : An integrative literature review

Sammanfattning

Background: Preventable maternal and newborn deaths remain unacceptably high in low-and middle-income countries. Despite strong evidence that midwife‑led models of care improve outcomes across the perinatal continuum a knowledge-to-practice gap for the sustained implementation in LMICs remains. Aim: This integrative review aims to explore the barriers and facilitators connected to sustained implementation of midwife-led models of care in low and middle-income countries. Methodology: An integrative literature review of 15 qualitative, quantitative and mixed-method studies explores the barriers and facilitators connected to sustained implementation of midwife-led models of care in low- and middle-income countries. PEO was used to identify keywords and database searches were performed on PubMed, CINAHL, and Web of Science to gather data. Inductive content analysis was used to identify barriers and facilitators. Results: Two overarching themes encompassing both barriers and facilitators were developed: health system and organizational factors, and sociocultural and interpersonal factors. Key barriers affecting the sustained implementation of midwife-led models of care were identified as workforce limitations, disrespectful care, limited involvement in policy for midwives, and organizational challenges. Facilitators were identified as supportive leadership, sufficient workforce capacity, education, access to training, community engagement, and respectful person-centered care. Conclusion: The evidence indicates that the successful implementation of midwife-led models of care is most achievable where enabling organizational structures and resources are in place, professional and community relationships support relational and respectful care, and midwifery philosophy is applied.