Empowering Perinatal Care: Implementation Strategies for Midwifery-Led Models in Primary Healthcare Systems [MOMENT] (EN)

Problem statement

In many countries, perinatal care is highly medicalized and fragmented. Pregnant women and families often experience a lack of continuity, limited freedom of choice, and insufficient person-centred support. International research has demonstrated that midwifery-led care models result in better maternal and neonatal outcomes, fewer unnecessary medical interventions, and more efficient use of healthcare resources.

Despite this strong scientific evidence, the implementation of midwifery-led care in primary and community care settings remains uneven and limited. This is due to organizational, professional, financial, and policy-related barriers that vary significantly across countries and healthcare systems. A clear gap exists between what research shows and what is applied in practice.

Research objective

The aim of this study is to develop sustainable implementation strategies for midwifery-led care models within primary care and community healthcare settings, adapted to different healthcare contexts.

The study seeks to provide policymakers and healthcare professionals with practical, evidence-based tools to effectively, affordably, and sustainably integrate midwifery-led care into existing healthcare systems.

Research question

The central research question is: How can midwifery-led care models be sustainably and context-sensitively implemented within primary care and community healthcare systems, and which policy, organizational, and professional strategies are required to achieve this?

Sub-questions include:

• Which midwifery-led care models currently exist in different countries?
• Which barriers and facilitating factors operate at the micro, meso, and macro levels?
• Which implementation strategies are most effective in specific contexts?
• What is the cost-effectiveness of midwifery-led care compared with physician-led care?

Research approach

The study uses a mixed-methods and participatory research approach conducted in Belgium (Flanders), Portugal, Spain, and Canada.

Key features include:

• Mapping existing care models: Analysis of existing midwifery-led care pathways, policy frameworks, and organizational models.
• Qualitative stakeholder research: Focus groups and interviews with women, families, midwives, physicians, healthcare organizations, and policymakers to identify barriers and opportunities.
• Co-creation and human-centred design: Local multidisciplinary teams, including healthcare users, collaboratively develop implementation plans, care pathways, and journey mapping exercises.
• Implementation and evaluation framework: Development of a step-by-step implementation framework with indicators for process, impact, and sustainability.
• Economic evaluation: Analysis of the cost-effectiveness of midwifery-led care compared with physician-led care models.
• International comparison and knowledge exchange: Learning from diverse healthcare systems to generate transferable insights.

Expected output

The study will produce practical and actionable outputs, including:

• A practical implementation framework for midwifery-led care adapted to different countries and contexts
• Care pathways and journey maps that visualize continuity and person-centred care
• Policy recommendations for regional, national, and international decision-makers
• A cost-effectiveness report to support investment decisions
• Practical tools for healthcare organizations and primary care teams
• Publicly accessible knowledge products, including a website, infographics, and policy briefs

Together, these outputs will contribute to better care closer to home, greater choice and continuity for women and families, and a future-proof healthcare system.

Researchers

• florence.dhaenens@kdg.be
• narjes.madhloum@kdg.be