Abstract
BackgroundMidwifery Units (MUs) are associated with optimal perinatal outcomes, improved service users’ and professionals’ satisfaction as well as being the most cost-effective option. However, they still do not represent the mainstream option of maternity care in many countries. Understanding effective strategies to integrate this model of care into maternity services could support and inform the MU implementation process that many countries and regions still need to approach.MethodsA systematic search and screening of qualitative and quantitative research about implementation of new MUs was conducted (Prospero protocol reference: CRD42019141443) using PRISMA guidelines. Included articles were appraised using the CASP checklist. A meta-synthesis approach to analysis was used. No exclusion criteria for time or context were applied to ensure inclusion of different implementation attempts even under different historical and social circumstances. A sensitivity analysis was conducted to reflect the major contribution of higher quality studies.ResultsFrom 1037 initial citations, twelve studies were identified for inclusion in this review after a screening process. The synthesis highlighted two broad categories: implementation readiness and strategies used. The first included aspects related to cultural, organisational and professional levels of the local context whilst the latter synthesised the main actions and key points identified in the included studies when implementing MUs. A logic model was created to synthesise and visually present the findings.ConclusionsThe studies selected were from a range of settings and time periods and used varying strategies. Nonetheless, consistencies were found across different implementation processes. These findings can be used in the systematic scaling up of MUs and can help in addressing barriers at system, service and individual levels. All three levels need to be addressed when implementing this model of care.
Highlights
Midwifery Units (MUs) are associated with optimal perinatal outcomes, improved service users’ and professionals’ satisfaction as well as being the most cost-effective option
MUs are a valid and evidence based model of care and their implementation has been recommended by many international guidelines and studies [3, 4, 31, 54, 55]
This is the first review that examines what kind of strategies have been used when implementing new MUs in different national contexts to identify what factors should be considered when adopting such innovation
Summary
Midwifery Units (MUs) are associated with optimal perinatal outcomes, improved service users’ and professionals’ satisfaction as well as being the most cost-effective option. They still do not represent the mainstream option of maternity care in many countries. A growing body of evidence has identified the impact and cost-effectiveness of midwifery models of care in improving maternal and newborn health [1, 2]. International studies have demonstrated that for healthy women with uncomplicated pregnancies, midwifery units (MUs) are associated with better maternal and similar perinatal outcomes compared to obstetric units (OUs) while being cost-effective and associated with high satisfaction amongst service users and midwives [5,6,7]. Stevens and Alonso (2020) expanded this definition for LMIC to include sexual and reproductive health as part of the main midwifery centre activities [10]
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