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Abstract

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 to knowledge, client-centeredness and capability. The review underscores the need for evidence-based strategies to overcome barriers and enhance facilitators.

Conclusion
Context-specific strategies informed by implementation science must be developed to support the sustainable integration of midwifery-led care models, with a particular emphasis on policy development and stakeholder engagement.

Publication Type:	Article
Additional Information:	© 2025 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Publisher Keywords:	Implementation science, Midwifery, Organisation & administration, Prenatal care, Systematic review
Subjects:	L Education > LB Theory and practice of education > LB2300 Higher Education R Medicine > RG Gynecology and obstetrics R Medicine > RT Nursing
Departments:	School of Health & Medical Sciences School of Health & Medical Sciences > Midwifery & Radiography
SWORD Depositor:	Symplectic Administrator

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