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Abstract

Background: Midwifery units (MUs) have been demonstrated to be safe for neonates, safer for mothers, cost effective and associated with staff and user satisfaction. In some EU countries MUs and midwife-led care are more established than others. Italy has one of the highest caesarean section rates in Europe and there are currently only few alongside midwifery units (AMUs). In Tuscany, a hospital is working towards the creation of its first AMU. The transition from the default obstetrically led maternity services to an integrated model with a MU represented an ideal opportunity to examine implementation of international guidelines in national and regional context.

Methods: This PhD aimed to explore the organisational, cultural and workforce factors influencing the implementation of a new midwifery unit in a European context using Participatory Action Research (PAR). Qualitative and quantitative methods were used and professionals, managers and service users were included. Starting from a systematic review of international literature and a situational analysis of the local context, local stakeholders codesigned an implementation plan in a collaborative way using a Delphi approach. Service users were included via focus group initially and via online surveys once the Covid 19 pandemic hit.

Findings: 86 professionals and managers and 522 service users took part in this study between 2019 and 2021. Barriers and facilitators were identified during systematic review and situational analysis. The local team identified ten themes to focus the implementation work on: team vision, creation of a multidisciplinary advisory group, creation of a dedicated group of midwives, implementation of the intrapartum guidelines for low-risk women, appropriate risk assessment, integration hospital-community, midwifery and multidisciplinary training, communication and information for service users, effective communication within the maternity team and reflective practice via audit and debriefing. Service users supported the initiatives proposed in the plan and expressed openness towards the MU implementation.

Conclusion: This was the first study observing the pre-implementation process of a MU in a European context including maternity team, managers and service users. A multi-layered approach to change is required when implementing this model of care addressing structural, organisational, professional and cultural issues. This work showed value in a participatory codesign approach to facilitate change. While this work is unique for the Italian context, the findings could help similar international contexts approaching this change

Publication Type:	Thesis (Doctoral)
Subjects:	R Medicine > RA Public aspects of medicine R Medicine > RT Nursing
Departments:	School of Health & Psychological Sciences > Midwifery & Radiography School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses Doctoral Theses

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