Barriers and facilitators to the implementation of a midwifery-led care model: a qualitative systematic review

作者：Andreia Soares Gonçalves, Márcia Pestana‐Santos, Christine McCourt, Ana Paula Prata · 发表于：Midwifery · 年份：2025 · DOI：10.1016/j.midw.2025.104514 · 被引用次数：1 · 研究领域：Maternal and Perinatal Health Interventions、Global Maternal and Child Health、Maternal Mental Health During Pregnancy and Postpartum

PROBLEM: Despite the overwhelming benefits of midwifery-led care models, in many countries, for several reasons, there is a resistance to their implementation. BACKGROUND: These care models provide both short-term and long-term advantages for mothers and newborn, demonstrate sustainability, and offer economic benefits. AIM: This qualitative systematic review explores and synthesises evidence on stakeholders' perceptions of the barriers and facilitators to implementing a shift from doctor-led or shared-care models to midwifery-led models of care. METHODS: The review followed Joanna Briggs Institute guidance for qualitative systematic reviews, including a comprehensive database search, study selection, quality appraisal by two independent reviewers, data extraction using a tool for qualitative findings, and thematic synthesis. The Consolidated Framework for Implementation Research guided the organisation and presentation of results, and the credibility and dependability of findings were assessed using ConQual. RESULTS AND DISCUSSION: Seven studies met the inclusion criteria. Fourteen findings, five facilitators and nine barriers, were identified by stakeholders including women, midwives, doctors and educators. These relate to four implementation domains: innovation, outer setting, inner setting, and individuals. Key themes included cost, local attitudes, local attitudes and conditions, laws and policies, tension for change, relationships, infrastructure, compatibility, access t...