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What are the strategies for implementing primary care models in maternity? A systematic review on midwifery units

Batinelli, L., Thaels, E., Leister, N. , McCourt, C. ORCID: 0000-0003-4765-5795, Bonciani, M. & Rocca-Ihenacho, L. ORCID: 0000-0002-8161-3938 (2022). What are the strategies for implementing primary care models in maternity? A systematic review on midwifery units. BMC Pregnancy and Childbirth, 22(1), 123. doi: 10.1186/s12884-022-04410-x


Midwifery 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.

A 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.

From 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.

The 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.

Publication Type: Article
Additional Information: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit
Publisher Keywords: Midwifery units, Midwifery led care, Birth centres, Midwifery centres, Primary care models, Implementation, Innovation, Adoption Metasynthesis, Qualitative research
Subjects: R Medicine > RG Gynecology and obstetrics
Departments: School of Health & Psychological Sciences > Midwifery & Radiography
Text - Published Version
Available under License Creative Commons: Attribution International Public License 4.0.

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